|
IMPLT BASEPLATE GLENOID DIAMETER 28MM
|
Facility
|
IP
|
$5,745.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002547
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,298.00 |
| Max. Negotiated Rate |
$5,457.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,596.00
|
| Rate for Payer: Cash Price |
$3,447.00
|
| Rate for Payer: Cash Price |
$3,447.00
|
| Rate for Payer: Cigna Commercial |
$4,883.25
|
| Rate for Payer: First Health Commercial |
$5,170.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,170.50
|
| Rate for Payer: GEHA Commercial |
$4,021.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,170.50
|
| Rate for Payer: Multiplan All |
$5,227.95
|
| Rate for Payer: OMNI Networks Commercial |
$4,021.50
|
| Rate for Payer: One Health Plan PPO/POS |
$5,170.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,457.75
|
| Rate for Payer: Three Rivers Provider Network All |
$4,308.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,342.85
|
| Rate for Payer: Zelis Auto |
$2,298.00
|
|
|
IMPLT BASEPLATE GLENOID DIAMETER 28MM
|
Facility
|
OP
|
$5,745.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003438
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,436.25 |
| Max. Negotiated Rate |
$5,457.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,447.00
|
| Rate for Payer: Cash Price |
$3,447.00
|
| Rate for Payer: Cash Price |
$3,447.00
|
| Rate for Payer: Cigna Commercial |
$4,883.25
|
| Rate for Payer: First Health Commercial |
$5,170.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,170.50
|
| Rate for Payer: GEHA Commercial |
$4,596.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,170.50
|
| Rate for Payer: Humana ChoiceCare |
$1,493.70
|
| Rate for Payer: Multiplan All |
$5,227.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,447.00
|
| Rate for Payer: OMNI Networks Commercial |
$4,021.50
|
| Rate for Payer: One Health Plan PPO/POS |
$5,170.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,457.75
|
| Rate for Payer: Three Rivers Provider Network All |
$4,308.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,055.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,436.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,342.85
|
| Rate for Payer: Zelis Auto |
$2,298.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,872.50
|
|
|
IMPLT BASEPLATE GLENOSPHERE 25MM
|
Facility
|
OP
|
$8,279.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001903
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,069.75 |
| Max. Negotiated Rate |
$7,865.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,967.40
|
| Rate for Payer: Cash Price |
$4,967.40
|
| Rate for Payer: Cash Price |
$4,967.40
|
| Rate for Payer: Cigna Commercial |
$7,037.15
|
| Rate for Payer: First Health Commercial |
$7,451.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,451.10
|
| Rate for Payer: GEHA Commercial |
$6,623.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,451.10
|
| Rate for Payer: Humana ChoiceCare |
$2,152.54
|
| Rate for Payer: Multiplan All |
$7,533.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,967.40
|
| Rate for Payer: OMNI Networks Commercial |
$5,795.30
|
| Rate for Payer: One Health Plan PPO/POS |
$7,451.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,865.05
|
| Rate for Payer: Three Rivers Provider Network All |
$6,209.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,285.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,069.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,699.47
|
| Rate for Payer: Zelis Auto |
$3,311.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,139.50
|
|
|
IMPLT BASEPLATE GLENOSPHERE 25MM
|
Facility
|
IP
|
$8,279.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001903
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,311.60 |
| Max. Negotiated Rate |
$7,865.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,623.20
|
| Rate for Payer: Cash Price |
$4,967.40
|
| Rate for Payer: Cash Price |
$4,967.40
|
| Rate for Payer: Cigna Commercial |
$7,037.15
|
| Rate for Payer: First Health Commercial |
$7,451.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,451.10
|
| Rate for Payer: GEHA Commercial |
$5,795.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,451.10
|
| Rate for Payer: Multiplan All |
$7,533.89
|
| Rate for Payer: OMNI Networks Commercial |
$5,795.30
|
| Rate for Payer: One Health Plan PPO/POS |
$7,451.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,865.05
|
| Rate for Payer: Three Rivers Provider Network All |
$6,209.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,699.47
|
| Rate for Payer: Zelis Auto |
$3,311.60
|
|
|
IMPLT BASEPLATE GLENOSPHERE HA
|
Facility
|
OP
|
$6,851.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001904
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,712.75 |
| Max. Negotiated Rate |
$6,508.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,110.60
|
| Rate for Payer: Cash Price |
$4,110.60
|
| Rate for Payer: Cash Price |
$4,110.60
|
| Rate for Payer: Cigna Commercial |
$5,823.35
|
| Rate for Payer: First Health Commercial |
$6,165.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,165.90
|
| Rate for Payer: GEHA Commercial |
$5,480.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,165.90
|
| Rate for Payer: Humana ChoiceCare |
$1,781.26
|
| Rate for Payer: Multiplan All |
$6,234.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,110.60
|
| Rate for Payer: OMNI Networks Commercial |
$4,795.70
|
| Rate for Payer: One Health Plan PPO/POS |
$6,165.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,508.45
|
| Rate for Payer: Three Rivers Provider Network All |
$5,138.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,028.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,712.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,371.43
|
| Rate for Payer: Zelis Auto |
$2,740.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,425.50
|
|
|
IMPLT BASEPLATE GLENOSPHERE HA
|
Facility
|
IP
|
$6,851.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001904
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,740.40 |
| Max. Negotiated Rate |
$6,508.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,480.80
|
| Rate for Payer: Cash Price |
$4,110.60
|
| Rate for Payer: Cash Price |
$4,110.60
|
| Rate for Payer: Cigna Commercial |
$5,823.35
|
| Rate for Payer: First Health Commercial |
$6,165.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,165.90
|
| Rate for Payer: GEHA Commercial |
$4,795.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,165.90
|
| Rate for Payer: Multiplan All |
$6,234.41
|
| Rate for Payer: OMNI Networks Commercial |
$4,795.70
|
| Rate for Payer: One Health Plan PPO/POS |
$6,165.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,508.45
|
| Rate for Payer: Three Rivers Provider Network All |
$5,138.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,371.43
|
| Rate for Payer: Zelis Auto |
$2,740.40
|
|
|
IMPLT BASE PLATE REVERSE SHOULDER
|
Facility
|
IP
|
$6,851.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001796
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,740.40 |
| Max. Negotiated Rate |
$6,508.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,480.80
|
| Rate for Payer: Cash Price |
$4,110.60
|
| Rate for Payer: Cash Price |
$4,110.60
|
| Rate for Payer: Cigna Commercial |
$5,823.35
|
| Rate for Payer: First Health Commercial |
$6,165.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,165.90
|
| Rate for Payer: GEHA Commercial |
$4,795.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,165.90
|
| Rate for Payer: Multiplan All |
$6,234.41
|
| Rate for Payer: OMNI Networks Commercial |
$4,795.70
|
| Rate for Payer: One Health Plan PPO/POS |
$6,165.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,508.45
|
| Rate for Payer: Three Rivers Provider Network All |
$5,138.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,371.43
|
| Rate for Payer: Zelis Auto |
$2,740.40
|
|
|
IMPLT BASE PLATE REVERSE SHOULDER
|
Facility
|
OP
|
$6,851.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001796
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,712.75 |
| Max. Negotiated Rate |
$6,508.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,110.60
|
| Rate for Payer: Cash Price |
$4,110.60
|
| Rate for Payer: Cash Price |
$4,110.60
|
| Rate for Payer: Cigna Commercial |
$5,823.35
|
| Rate for Payer: First Health Commercial |
$6,165.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,165.90
|
| Rate for Payer: GEHA Commercial |
$5,480.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,165.90
|
| Rate for Payer: Humana ChoiceCare |
$1,781.26
|
| Rate for Payer: Multiplan All |
$6,234.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,110.60
|
| Rate for Payer: OMNI Networks Commercial |
$4,795.70
|
| Rate for Payer: One Health Plan PPO/POS |
$6,165.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,508.45
|
| Rate for Payer: Three Rivers Provider Network All |
$5,138.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,028.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,712.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,371.43
|
| Rate for Payer: Zelis Auto |
$2,740.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,425.50
|
|
|
IMPLT BASEPLATE TIBIAL 6 SIZE LM/RL
|
Facility
|
IP
|
$3,730.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001889
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,492.00 |
| Max. Negotiated Rate |
$3,543.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,984.00
|
| Rate for Payer: Cash Price |
$2,238.00
|
| Rate for Payer: Cash Price |
$2,238.00
|
| Rate for Payer: Cigna Commercial |
$3,170.50
|
| Rate for Payer: First Health Commercial |
$3,357.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,357.00
|
| Rate for Payer: GEHA Commercial |
$2,611.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,357.00
|
| Rate for Payer: Multiplan All |
$3,394.30
|
| Rate for Payer: OMNI Networks Commercial |
$2,611.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,357.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,543.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,797.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,468.90
|
| Rate for Payer: Zelis Auto |
$1,492.00
|
|
|
IMPLT BASEPLATE TIBIAL 6 SIZE LM/RL
|
Facility
|
OP
|
$3,730.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001889
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$932.50 |
| Max. Negotiated Rate |
$3,543.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,238.00
|
| Rate for Payer: Cash Price |
$2,238.00
|
| Rate for Payer: Cash Price |
$2,238.00
|
| Rate for Payer: Cigna Commercial |
$3,170.50
|
| Rate for Payer: First Health Commercial |
$3,357.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,357.00
|
| Rate for Payer: GEHA Commercial |
$2,984.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,357.00
|
| Rate for Payer: Humana ChoiceCare |
$969.80
|
| Rate for Payer: Multiplan All |
$3,394.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,238.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,611.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,357.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,543.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,797.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,282.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$932.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,468.90
|
| Rate for Payer: Zelis Auto |
$1,492.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,865.00
|
|
|
IMPLT BASEPLATE TIBIAL #7
|
Facility
|
OP
|
$3,599.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001905
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$899.75 |
| Max. Negotiated Rate |
$3,419.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,159.40
|
| Rate for Payer: Cash Price |
$2,159.40
|
| Rate for Payer: Cash Price |
$2,159.40
|
| Rate for Payer: Cigna Commercial |
$3,059.15
|
| Rate for Payer: First Health Commercial |
$3,239.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,239.10
|
| Rate for Payer: GEHA Commercial |
$2,879.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,239.10
|
| Rate for Payer: Humana ChoiceCare |
$935.74
|
| Rate for Payer: Multiplan All |
$3,275.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,159.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,519.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,239.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,419.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,699.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,167.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$899.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,347.07
|
| Rate for Payer: Zelis Auto |
$1,439.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,799.50
|
|
|
IMPLT BASEPLATE TIBIAL #7
|
Facility
|
IP
|
$3,599.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001905
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,439.60 |
| Max. Negotiated Rate |
$3,419.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,879.20
|
| Rate for Payer: Cash Price |
$2,159.40
|
| Rate for Payer: Cash Price |
$2,159.40
|
| Rate for Payer: Cigna Commercial |
$3,059.15
|
| Rate for Payer: First Health Commercial |
$3,239.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,239.10
|
| Rate for Payer: GEHA Commercial |
$2,519.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,239.10
|
| Rate for Payer: Multiplan All |
$3,275.09
|
| Rate for Payer: OMNI Networks Commercial |
$2,519.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,239.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,419.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,699.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,347.07
|
| Rate for Payer: Zelis Auto |
$1,439.60
|
|
|
IMPLT BASEPLATE TIBIAL #8
|
Facility
|
OP
|
$3,599.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001906
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$899.75 |
| Max. Negotiated Rate |
$3,419.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,159.40
|
| Rate for Payer: Cash Price |
$2,159.40
|
| Rate for Payer: Cash Price |
$2,159.40
|
| Rate for Payer: Cigna Commercial |
$3,059.15
|
| Rate for Payer: First Health Commercial |
$3,239.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,239.10
|
| Rate for Payer: GEHA Commercial |
$2,879.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,239.10
|
| Rate for Payer: Humana ChoiceCare |
$935.74
|
| Rate for Payer: Multiplan All |
$3,275.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,159.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,519.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,239.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,419.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,699.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,167.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$899.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,347.07
|
| Rate for Payer: Zelis Auto |
$1,439.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,799.50
|
|
|
IMPLT BASEPLATE TIBIAL #8
|
Facility
|
IP
|
$3,599.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001906
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,439.60 |
| Max. Negotiated Rate |
$3,419.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,879.20
|
| Rate for Payer: Cash Price |
$2,159.40
|
| Rate for Payer: Cash Price |
$2,159.40
|
| Rate for Payer: Cigna Commercial |
$3,059.15
|
| Rate for Payer: First Health Commercial |
$3,239.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,239.10
|
| Rate for Payer: GEHA Commercial |
$2,519.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,239.10
|
| Rate for Payer: Multiplan All |
$3,275.09
|
| Rate for Payer: OMNI Networks Commercial |
$2,519.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,239.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,419.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,699.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,347.07
|
| Rate for Payer: Zelis Auto |
$1,439.60
|
|
|
IMPLT BASEPLATE TIBIAL INSERT 2
|
Facility
|
OP
|
$3,299.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006722
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$824.75 |
| Max. Negotiated Rate |
$3,134.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,979.40
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cigna Commercial |
$2,804.15
|
| Rate for Payer: First Health Commercial |
$2,969.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,969.10
|
| Rate for Payer: GEHA Commercial |
$2,639.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,969.10
|
| Rate for Payer: Humana ChoiceCare |
$857.74
|
| Rate for Payer: Multiplan All |
$3,002.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,979.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,309.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,969.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,134.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,474.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,903.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$824.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,068.07
|
| Rate for Payer: Zelis Auto |
$1,319.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,649.50
|
|
|
IMPLT BASEPLATE TIBIAL INSERT 2
|
Facility
|
IP
|
$3,299.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006722
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,319.60 |
| Max. Negotiated Rate |
$3,134.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,639.20
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cigna Commercial |
$2,804.15
|
| Rate for Payer: First Health Commercial |
$2,969.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,969.10
|
| Rate for Payer: GEHA Commercial |
$2,309.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,969.10
|
| Rate for Payer: Multiplan All |
$3,002.09
|
| Rate for Payer: OMNI Networks Commercial |
$2,309.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,969.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,134.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,474.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,068.07
|
| Rate for Payer: Zelis Auto |
$1,319.60
|
|
|
IMPLT BASEPLATE TIBIAL INSERT 3
|
Facility
|
OP
|
$3,299.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003472
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$824.75 |
| Max. Negotiated Rate |
$3,134.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,979.40
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cigna Commercial |
$2,804.15
|
| Rate for Payer: First Health Commercial |
$2,969.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,969.10
|
| Rate for Payer: GEHA Commercial |
$2,639.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,969.10
|
| Rate for Payer: Humana ChoiceCare |
$857.74
|
| Rate for Payer: Multiplan All |
$3,002.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,979.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,309.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,969.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,134.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,474.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,903.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$824.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,068.07
|
| Rate for Payer: Zelis Auto |
$1,319.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,649.50
|
|
|
IMPLT BASEPLATE TIBIAL INSERT 3
|
Facility
|
OP
|
$3,299.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006708
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$824.75 |
| Max. Negotiated Rate |
$3,134.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,979.40
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cigna Commercial |
$2,804.15
|
| Rate for Payer: First Health Commercial |
$2,969.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,969.10
|
| Rate for Payer: GEHA Commercial |
$2,639.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,969.10
|
| Rate for Payer: Humana ChoiceCare |
$857.74
|
| Rate for Payer: Multiplan All |
$3,002.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,979.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,309.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,969.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,134.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,474.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,903.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$824.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,068.07
|
| Rate for Payer: Zelis Auto |
$1,319.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,649.50
|
|
|
IMPLT BASEPLATE TIBIAL INSERT 3
|
Facility
|
IP
|
$3,299.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006719
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,319.60 |
| Max. Negotiated Rate |
$3,134.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,639.20
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cigna Commercial |
$2,804.15
|
| Rate for Payer: First Health Commercial |
$2,969.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,969.10
|
| Rate for Payer: GEHA Commercial |
$2,309.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,969.10
|
| Rate for Payer: Multiplan All |
$3,002.09
|
| Rate for Payer: OMNI Networks Commercial |
$2,309.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,969.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,134.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,474.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,068.07
|
| Rate for Payer: Zelis Auto |
$1,319.60
|
|
|
IMPLT BASEPLATE TIBIAL INSERT 3
|
Facility
|
IP
|
$3,299.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006708
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,319.60 |
| Max. Negotiated Rate |
$3,134.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,639.20
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cigna Commercial |
$2,804.15
|
| Rate for Payer: First Health Commercial |
$2,969.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,969.10
|
| Rate for Payer: GEHA Commercial |
$2,309.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,969.10
|
| Rate for Payer: Multiplan All |
$3,002.09
|
| Rate for Payer: OMNI Networks Commercial |
$2,309.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,969.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,134.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,474.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,068.07
|
| Rate for Payer: Zelis Auto |
$1,319.60
|
|
|
IMPLT BASEPLATE TIBIAL INSERT 3
|
Facility
|
IP
|
$3,299.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003472
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,319.60 |
| Max. Negotiated Rate |
$3,134.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,639.20
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cigna Commercial |
$2,804.15
|
| Rate for Payer: First Health Commercial |
$2,969.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,969.10
|
| Rate for Payer: GEHA Commercial |
$2,309.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,969.10
|
| Rate for Payer: Multiplan All |
$3,002.09
|
| Rate for Payer: OMNI Networks Commercial |
$2,309.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,969.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,134.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,474.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,068.07
|
| Rate for Payer: Zelis Auto |
$1,319.60
|
|
|
IMPLT BASEPLATE TIBIAL INSERT 3
|
Facility
|
OP
|
$3,299.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006719
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$824.75 |
| Max. Negotiated Rate |
$3,134.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,979.40
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cigna Commercial |
$2,804.15
|
| Rate for Payer: First Health Commercial |
$2,969.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,969.10
|
| Rate for Payer: GEHA Commercial |
$2,639.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,969.10
|
| Rate for Payer: Humana ChoiceCare |
$857.74
|
| Rate for Payer: Multiplan All |
$3,002.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,979.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,309.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,969.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,134.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,474.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,903.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$824.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,068.07
|
| Rate for Payer: Zelis Auto |
$1,319.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,649.50
|
|
|
IMPLT BASEPLATE TIBIAL INSERT 4
|
Facility
|
OP
|
$3,299.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006462
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$824.75 |
| Max. Negotiated Rate |
$3,134.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,979.40
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cigna Commercial |
$2,804.15
|
| Rate for Payer: First Health Commercial |
$2,969.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,969.10
|
| Rate for Payer: GEHA Commercial |
$2,639.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,969.10
|
| Rate for Payer: Humana ChoiceCare |
$857.74
|
| Rate for Payer: Multiplan All |
$3,002.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,979.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,309.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,969.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,134.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,474.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,903.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$824.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,068.07
|
| Rate for Payer: Zelis Auto |
$1,319.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,649.50
|
|
|
IMPLT BASEPLATE TIBIAL INSERT 4
|
Facility
|
IP
|
$3,299.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,319.60 |
| Max. Negotiated Rate |
$3,134.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,639.20
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cigna Commercial |
$2,804.15
|
| Rate for Payer: First Health Commercial |
$2,969.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,969.10
|
| Rate for Payer: GEHA Commercial |
$2,309.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,969.10
|
| Rate for Payer: Multiplan All |
$3,002.09
|
| Rate for Payer: OMNI Networks Commercial |
$2,309.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,969.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,134.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,474.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,068.07
|
| Rate for Payer: Zelis Auto |
$1,319.60
|
|
|
IMPLT BASEPLATE TIBIAL INSERT 4
|
Facility
|
OP
|
$3,299.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$824.75 |
| Max. Negotiated Rate |
$3,134.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,979.40
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cigna Commercial |
$2,804.15
|
| Rate for Payer: First Health Commercial |
$2,969.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,969.10
|
| Rate for Payer: GEHA Commercial |
$2,639.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,969.10
|
| Rate for Payer: Humana ChoiceCare |
$857.74
|
| Rate for Payer: Multiplan All |
$3,002.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,979.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,309.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,969.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,134.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,474.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,903.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$824.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,068.07
|
| Rate for Payer: Zelis Auto |
$1,319.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,649.50
|
|
