|
IMPLT AUGMENT POSTERIOR FEMORAL SIZE 7
|
Facility
|
IP
|
$3,883.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002640
|
|
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 TIBIAL 10X71MM
|
Facility
|
OP
|
$4,266.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001791
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,066.50 |
| Max. Negotiated Rate |
$4,052.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,559.60
|
| Rate for Payer: Cash Price |
$2,559.60
|
| Rate for Payer: Cash Price |
$2,559.60
|
| Rate for Payer: Cigna Commercial |
$3,626.10
|
| Rate for Payer: First Health Commercial |
$3,839.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,839.40
|
| Rate for Payer: GEHA Commercial |
$3,412.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,839.40
|
| Rate for Payer: Humana ChoiceCare |
$1,109.16
|
| Rate for Payer: Multiplan All |
$3,882.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,559.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,986.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,839.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,052.70
|
| Rate for Payer: Three Rivers Provider Network All |
$3,199.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,754.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,066.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,967.38
|
| Rate for Payer: Zelis Auto |
$1,706.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,133.00
|
|
|
IMPLT AUGMENT TIBIAL 10X71MM
|
Facility
|
IP
|
$4,266.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001791
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,706.40 |
| Max. Negotiated Rate |
$4,052.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,412.80
|
| Rate for Payer: Cash Price |
$2,559.60
|
| Rate for Payer: Cash Price |
$2,559.60
|
| Rate for Payer: Cigna Commercial |
$3,626.10
|
| Rate for Payer: First Health Commercial |
$3,839.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,839.40
|
| Rate for Payer: GEHA Commercial |
$2,986.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,839.40
|
| Rate for Payer: Multiplan All |
$3,882.06
|
| Rate for Payer: OMNI Networks Commercial |
$2,986.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,839.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,052.70
|
| Rate for Payer: Three Rivers Provider Network All |
$3,199.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,967.38
|
| Rate for Payer: Zelis Auto |
$1,706.40
|
|
|
IMPLT AUGMENT TIBIAL BLOCK HALF #3 10MM
|
Facility
|
IP
|
$3,648.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003406
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,459.20 |
| Max. Negotiated Rate |
$3,465.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,918.40
|
| Rate for Payer: Cash Price |
$2,188.80
|
| Rate for Payer: Cash Price |
$2,188.80
|
| Rate for Payer: Cigna Commercial |
$3,100.80
|
| Rate for Payer: First Health Commercial |
$3,283.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,283.20
|
| Rate for Payer: GEHA Commercial |
$2,553.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,283.20
|
| Rate for Payer: Multiplan All |
$3,319.68
|
| Rate for Payer: OMNI Networks Commercial |
$2,553.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,283.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,465.60
|
| Rate for Payer: Three Rivers Provider Network All |
$2,736.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,392.64
|
| Rate for Payer: Zelis Auto |
$1,459.20
|
|
|
IMPLT AUGMENT TIBIAL BLOCK HALF #3 10MM
|
Facility
|
OP
|
$3,648.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003405
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$912.00 |
| Max. Negotiated Rate |
$3,465.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,188.80
|
| Rate for Payer: Cash Price |
$2,188.80
|
| Rate for Payer: Cash Price |
$2,188.80
|
| Rate for Payer: Cigna Commercial |
$3,100.80
|
| Rate for Payer: First Health Commercial |
$3,283.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,283.20
|
| Rate for Payer: GEHA Commercial |
$2,918.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,283.20
|
| Rate for Payer: Humana ChoiceCare |
$948.48
|
| Rate for Payer: Multiplan All |
$3,319.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,188.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,553.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,283.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,465.60
|
| Rate for Payer: Three Rivers Provider Network All |
$2,736.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,210.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$912.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,392.64
|
| Rate for Payer: Zelis Auto |
$1,459.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,824.00
|
|
|
IMPLT AUGMENT TIBIAL BLOCK HALF #3 10MM
|
Facility
|
IP
|
$3,648.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003405
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,459.20 |
| Max. Negotiated Rate |
$3,465.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,918.40
|
| Rate for Payer: Cash Price |
$2,188.80
|
| Rate for Payer: Cash Price |
$2,188.80
|
| Rate for Payer: Cigna Commercial |
$3,100.80
|
| Rate for Payer: First Health Commercial |
$3,283.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,283.20
|
| Rate for Payer: GEHA Commercial |
$2,553.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,283.20
|
| Rate for Payer: Multiplan All |
$3,319.68
|
| Rate for Payer: OMNI Networks Commercial |
$2,553.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,283.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,465.60
|
| Rate for Payer: Three Rivers Provider Network All |
$2,736.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,392.64
|
| Rate for Payer: Zelis Auto |
$1,459.20
|
|
|
IMPLT AUGMENT TIBIAL BLOCK HALF #3 10MM
|
Facility
|
OP
|
$3,648.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003406
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$912.00 |
| Max. Negotiated Rate |
$3,465.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,188.80
|
| Rate for Payer: Cash Price |
$2,188.80
|
| Rate for Payer: Cash Price |
$2,188.80
|
| Rate for Payer: Cigna Commercial |
$3,100.80
|
| Rate for Payer: First Health Commercial |
$3,283.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,283.20
|
| Rate for Payer: GEHA Commercial |
$2,918.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,283.20
|
| Rate for Payer: Humana ChoiceCare |
$948.48
|
| Rate for Payer: Multiplan All |
$3,319.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,188.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,553.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,283.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,465.60
|
| Rate for Payer: Three Rivers Provider Network All |
$2,736.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,210.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$912.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,392.64
|
| Rate for Payer: Zelis Auto |
$1,459.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,824.00
|
|
|
IMPLT AUGMENT TIBIAL BLOCK HALF #3 5MM
|
Facility
|
OP
|
$3,499.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002648
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$874.75 |
| Max. Negotiated Rate |
$3,324.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,099.40
|
| Rate for Payer: Cash Price |
$2,099.40
|
| Rate for Payer: Cash Price |
$2,099.40
|
| Rate for Payer: Cigna Commercial |
$2,974.15
|
| Rate for Payer: First Health Commercial |
$3,149.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,149.10
|
| Rate for Payer: GEHA Commercial |
$2,799.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,149.10
|
| Rate for Payer: Humana ChoiceCare |
$909.74
|
| Rate for Payer: Multiplan All |
$3,184.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,099.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,449.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,149.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,324.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,624.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,079.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$874.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,254.07
|
| Rate for Payer: Zelis Auto |
$1,399.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,749.50
|
|
|
IMPLT AUGMENT TIBIAL BLOCK HALF #3 5MM
|
Facility
|
IP
|
$3,499.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002648
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,399.60 |
| Max. Negotiated Rate |
$3,324.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,799.20
|
| Rate for Payer: Cash Price |
$2,099.40
|
| Rate for Payer: Cash Price |
$2,099.40
|
| Rate for Payer: Cigna Commercial |
$2,974.15
|
| Rate for Payer: First Health Commercial |
$3,149.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,149.10
|
| Rate for Payer: GEHA Commercial |
$2,449.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,149.10
|
| Rate for Payer: Multiplan All |
$3,184.09
|
| Rate for Payer: OMNI Networks Commercial |
$2,449.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,149.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,324.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,624.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,254.07
|
| Rate for Payer: Zelis Auto |
$1,399.60
|
|
|
IMPLT AUGMENT TIBIAL BLOCK HALF #3 5MM
|
Facility
|
OP
|
$3,499.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003137
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$874.75 |
| Max. Negotiated Rate |
$3,324.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,099.40
|
| Rate for Payer: Cash Price |
$2,099.40
|
| Rate for Payer: Cash Price |
$2,099.40
|
| Rate for Payer: Cigna Commercial |
$2,974.15
|
| Rate for Payer: First Health Commercial |
$3,149.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,149.10
|
| Rate for Payer: GEHA Commercial |
$2,799.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,149.10
|
| Rate for Payer: Humana ChoiceCare |
$909.74
|
| Rate for Payer: Multiplan All |
$3,184.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,099.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,449.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,149.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,324.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,624.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,079.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$874.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,254.07
|
| Rate for Payer: Zelis Auto |
$1,399.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,749.50
|
|
|
IMPLT AUGMENT TIBIAL BLOCK HALF #3 5MM
|
Facility
|
IP
|
$3,499.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003137
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,399.60 |
| Max. Negotiated Rate |
$3,324.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,799.20
|
| Rate for Payer: Cash Price |
$2,099.40
|
| Rate for Payer: Cash Price |
$2,099.40
|
| Rate for Payer: Cigna Commercial |
$2,974.15
|
| Rate for Payer: First Health Commercial |
$3,149.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,149.10
|
| Rate for Payer: GEHA Commercial |
$2,449.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,149.10
|
| Rate for Payer: Multiplan All |
$3,184.09
|
| Rate for Payer: OMNI Networks Commercial |
$2,449.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,149.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,324.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,624.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,254.07
|
| Rate for Payer: Zelis Auto |
$1,399.60
|
|
|
IMPLT AUGMENT TIBIAL BLOCK HALF #4 10MM
|
Facility
|
OP
|
$3,436.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003044
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$859.00 |
| Max. Negotiated Rate |
$3,264.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,061.60
|
| Rate for Payer: Cash Price |
$2,061.60
|
| Rate for Payer: Cash Price |
$2,061.60
|
| Rate for Payer: Cigna Commercial |
$2,920.60
|
| Rate for Payer: First Health Commercial |
$3,092.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,092.40
|
| Rate for Payer: GEHA Commercial |
$2,748.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,092.40
|
| Rate for Payer: Humana ChoiceCare |
$893.36
|
| Rate for Payer: Multiplan All |
$3,126.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,061.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,405.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,092.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,264.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,577.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,023.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$859.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,195.48
|
| Rate for Payer: Zelis Auto |
$1,374.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,718.00
|
|
|
IMPLT AUGMENT TIBIAL BLOCK HALF #4 10MM
|
Facility
|
OP
|
$3,436.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$859.00 |
| Max. Negotiated Rate |
$3,264.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,061.60
|
| Rate for Payer: Cash Price |
$2,061.60
|
| Rate for Payer: Cash Price |
$2,061.60
|
| Rate for Payer: Cigna Commercial |
$2,920.60
|
| Rate for Payer: First Health Commercial |
$3,092.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,092.40
|
| Rate for Payer: GEHA Commercial |
$2,748.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,092.40
|
| Rate for Payer: Humana ChoiceCare |
$893.36
|
| Rate for Payer: Multiplan All |
$3,126.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,061.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,405.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,092.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,264.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,577.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,023.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$859.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,195.48
|
| Rate for Payer: Zelis Auto |
$1,374.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,718.00
|
|
|
IMPLT AUGMENT TIBIAL BLOCK HALF #4 10MM
|
Facility
|
IP
|
$3,436.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003044
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,374.40 |
| Max. Negotiated Rate |
$3,264.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,748.80
|
| Rate for Payer: Cash Price |
$2,061.60
|
| Rate for Payer: Cash Price |
$2,061.60
|
| Rate for Payer: Cigna Commercial |
$2,920.60
|
| Rate for Payer: First Health Commercial |
$3,092.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,092.40
|
| Rate for Payer: GEHA Commercial |
$2,405.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,092.40
|
| Rate for Payer: Multiplan All |
$3,126.76
|
| Rate for Payer: OMNI Networks Commercial |
$2,405.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,092.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,264.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,577.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,195.48
|
| Rate for Payer: Zelis Auto |
$1,374.40
|
|
|
IMPLT AUGMENT TIBIAL BLOCK HALF #4 10MM
|
Facility
|
IP
|
$3,436.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,374.40 |
| Max. Negotiated Rate |
$3,264.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,748.80
|
| Rate for Payer: Cash Price |
$2,061.60
|
| Rate for Payer: Cash Price |
$2,061.60
|
| Rate for Payer: Cigna Commercial |
$2,920.60
|
| Rate for Payer: First Health Commercial |
$3,092.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,092.40
|
| Rate for Payer: GEHA Commercial |
$2,405.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,092.40
|
| Rate for Payer: Multiplan All |
$3,126.76
|
| Rate for Payer: OMNI Networks Commercial |
$2,405.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,092.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,264.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,577.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,195.48
|
| Rate for Payer: Zelis Auto |
$1,374.40
|
|
|
IMPLT AUGMENT TIBIAL BLOCK HALF 4 SIZE
|
Facility
|
OP
|
$3,799.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006351
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$949.75 |
| Max. Negotiated Rate |
$3,609.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,279.40
|
| Rate for Payer: Cash Price |
$2,279.40
|
| Rate for Payer: Cash Price |
$2,279.40
|
| Rate for Payer: Cigna Commercial |
$3,229.15
|
| Rate for Payer: First Health Commercial |
$3,419.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,419.10
|
| Rate for Payer: GEHA Commercial |
$3,039.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,419.10
|
| Rate for Payer: Humana ChoiceCare |
$987.74
|
| Rate for Payer: Multiplan All |
$3,457.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,279.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,659.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,419.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,609.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,849.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,343.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$949.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,533.07
|
| Rate for Payer: Zelis Auto |
$1,519.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,899.50
|
|
|
IMPLT AUGMENT TIBIAL BLOCK HALF 4 SIZE
|
Facility
|
IP
|
$3,799.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006351
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,519.60 |
| Max. Negotiated Rate |
$3,609.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,039.20
|
| Rate for Payer: Cash Price |
$2,279.40
|
| Rate for Payer: Cash Price |
$2,279.40
|
| Rate for Payer: Cigna Commercial |
$3,229.15
|
| Rate for Payer: First Health Commercial |
$3,419.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,419.10
|
| Rate for Payer: GEHA Commercial |
$2,659.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,419.10
|
| Rate for Payer: Multiplan All |
$3,457.09
|
| Rate for Payer: OMNI Networks Commercial |
$2,659.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,419.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,609.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,849.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,533.07
|
| Rate for Payer: Zelis Auto |
$1,519.60
|
|
|
IMPLT AUGMENT TIBIAL BLOCK HALF #5 10MM
|
Facility
|
OP
|
$3,543.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002737
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$885.75 |
| Max. Negotiated Rate |
$3,365.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,125.80
|
| Rate for Payer: Cash Price |
$2,125.80
|
| Rate for Payer: Cash Price |
$2,125.80
|
| Rate for Payer: Cigna Commercial |
$3,011.55
|
| Rate for Payer: First Health Commercial |
$3,188.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,188.70
|
| Rate for Payer: GEHA Commercial |
$2,834.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,188.70
|
| Rate for Payer: Humana ChoiceCare |
$921.18
|
| Rate for Payer: Multiplan All |
$3,224.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,125.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,480.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,188.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,365.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2,657.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,117.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$885.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,294.99
|
| Rate for Payer: Zelis Auto |
$1,417.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,771.50
|
|
|
IMPLT AUGMENT TIBIAL BLOCK HALF #5 10MM
|
Facility
|
OP
|
$3,436.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002955
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$859.00 |
| Max. Negotiated Rate |
$3,264.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,061.60
|
| Rate for Payer: Cash Price |
$2,061.60
|
| Rate for Payer: Cash Price |
$2,061.60
|
| Rate for Payer: Cigna Commercial |
$2,920.60
|
| Rate for Payer: First Health Commercial |
$3,092.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,092.40
|
| Rate for Payer: GEHA Commercial |
$2,748.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,092.40
|
| Rate for Payer: Humana ChoiceCare |
$893.36
|
| Rate for Payer: Multiplan All |
$3,126.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,061.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,405.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,092.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,264.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,577.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,023.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$859.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,195.48
|
| Rate for Payer: Zelis Auto |
$1,374.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,718.00
|
|
|
IMPLT AUGMENT TIBIAL BLOCK HALF #5 10MM
|
Facility
|
IP
|
$3,543.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002737
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,417.20 |
| Max. Negotiated Rate |
$3,365.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,834.40
|
| Rate for Payer: Cash Price |
$2,125.80
|
| Rate for Payer: Cash Price |
$2,125.80
|
| Rate for Payer: Cigna Commercial |
$3,011.55
|
| Rate for Payer: First Health Commercial |
$3,188.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,188.70
|
| Rate for Payer: GEHA Commercial |
$2,480.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,188.70
|
| Rate for Payer: Multiplan All |
$3,224.13
|
| Rate for Payer: OMNI Networks Commercial |
$2,480.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,188.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,365.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2,657.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,294.99
|
| Rate for Payer: Zelis Auto |
$1,417.20
|
|
|
IMPLT AUGMENT TIBIAL BLOCK HALF #5 10MM
|
Facility
|
IP
|
$3,436.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002955
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,374.40 |
| Max. Negotiated Rate |
$3,264.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,748.80
|
| Rate for Payer: Cash Price |
$2,061.60
|
| Rate for Payer: Cash Price |
$2,061.60
|
| Rate for Payer: Cigna Commercial |
$2,920.60
|
| Rate for Payer: First Health Commercial |
$3,092.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,092.40
|
| Rate for Payer: GEHA Commercial |
$2,405.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,092.40
|
| Rate for Payer: Multiplan All |
$3,126.76
|
| Rate for Payer: OMNI Networks Commercial |
$2,405.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,092.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,264.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,577.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,195.48
|
| Rate for Payer: Zelis Auto |
$1,374.40
|
|
|
IMPLT AUGMENT TIBIAL BLOCK HALF 5MM #7
|
Facility
|
OP
|
$3,609.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003101
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$902.25 |
| Max. Negotiated Rate |
$3,428.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,165.40
|
| Rate for Payer: Cash Price |
$2,165.40
|
| Rate for Payer: Cash Price |
$2,165.40
|
| Rate for Payer: Cigna Commercial |
$3,067.65
|
| Rate for Payer: First Health Commercial |
$3,248.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,248.10
|
| Rate for Payer: GEHA Commercial |
$2,887.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,248.10
|
| Rate for Payer: Humana ChoiceCare |
$938.34
|
| Rate for Payer: Multiplan All |
$3,284.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,165.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,526.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,248.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,428.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,706.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,175.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$902.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,356.37
|
| Rate for Payer: Zelis Auto |
$1,443.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,804.50
|
|
|
IMPLT AUGMENT TIBIAL BLOCK HALF 5MM #7
|
Facility
|
IP
|
$3,609.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003101
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,443.60 |
| Max. Negotiated Rate |
$3,428.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,887.20
|
| Rate for Payer: Cash Price |
$2,165.40
|
| Rate for Payer: Cash Price |
$2,165.40
|
| Rate for Payer: Cigna Commercial |
$3,067.65
|
| Rate for Payer: First Health Commercial |
$3,248.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,248.10
|
| Rate for Payer: GEHA Commercial |
$2,526.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,248.10
|
| Rate for Payer: Multiplan All |
$3,284.19
|
| Rate for Payer: OMNI Networks Commercial |
$2,526.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,248.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,428.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,706.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,356.37
|
| Rate for Payer: Zelis Auto |
$1,443.60
|
|
|
IMPLT AUGMENT TIBIAL BLOCK HALF 5MM #7
|
Facility
|
IP
|
$3,609.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003100
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,443.60 |
| Max. Negotiated Rate |
$3,428.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,887.20
|
| Rate for Payer: Cash Price |
$2,165.40
|
| Rate for Payer: Cash Price |
$2,165.40
|
| Rate for Payer: Cigna Commercial |
$3,067.65
|
| Rate for Payer: First Health Commercial |
$3,248.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,248.10
|
| Rate for Payer: GEHA Commercial |
$2,526.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,248.10
|
| Rate for Payer: Multiplan All |
$3,284.19
|
| Rate for Payer: OMNI Networks Commercial |
$2,526.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,248.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,428.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,706.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,356.37
|
| Rate for Payer: Zelis Auto |
$1,443.60
|
|
|
IMPLT AUGMENT TIBIAL BLOCK HALF 5MM #7
|
Facility
|
OP
|
$3,609.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003100
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$902.25 |
| Max. Negotiated Rate |
$3,428.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,165.40
|
| Rate for Payer: Cash Price |
$2,165.40
|
| Rate for Payer: Cash Price |
$2,165.40
|
| Rate for Payer: Cigna Commercial |
$3,067.65
|
| Rate for Payer: First Health Commercial |
$3,248.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,248.10
|
| Rate for Payer: GEHA Commercial |
$2,887.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,248.10
|
| Rate for Payer: Humana ChoiceCare |
$938.34
|
| Rate for Payer: Multiplan All |
$3,284.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,165.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,526.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,248.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,428.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,706.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,175.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$902.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,356.37
|
| Rate for Payer: Zelis Auto |
$1,443.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,804.50
|
|
