|
IMPLT COMPONENT BIPOLAR HEAD UNIVERSAL
|
Facility
|
OP
|
$2,225.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003151
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$556.25 |
| Max. Negotiated Rate |
$2,113.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,335.00
|
| Rate for Payer: Cash Price |
$1,335.00
|
| Rate for Payer: Cash Price |
$1,335.00
|
| Rate for Payer: Cigna Commercial |
$1,891.25
|
| Rate for Payer: First Health Commercial |
$2,002.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,002.50
|
| Rate for Payer: GEHA Commercial |
$1,780.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,002.50
|
| Rate for Payer: Humana ChoiceCare |
$578.50
|
| Rate for Payer: Multiplan All |
$2,024.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,335.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,557.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,002.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,113.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,668.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,958.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$556.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,069.25
|
| Rate for Payer: Zelis Auto |
$890.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,112.50
|
|
|
IMPLT COMPONENT FEMORAL 17 SIZE
|
Facility
|
OP
|
$7,064.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001917
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,766.00 |
| Max. Negotiated Rate |
$6,710.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,238.40
|
| Rate for Payer: Cash Price |
$4,238.40
|
| Rate for Payer: Cash Price |
$4,238.40
|
| Rate for Payer: Cigna Commercial |
$6,004.40
|
| Rate for Payer: First Health Commercial |
$6,357.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,357.60
|
| Rate for Payer: GEHA Commercial |
$5,651.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,357.60
|
| Rate for Payer: Humana ChoiceCare |
$1,836.64
|
| Rate for Payer: Multiplan All |
$6,428.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,238.40
|
| Rate for Payer: OMNI Networks Commercial |
$4,944.80
|
| Rate for Payer: One Health Plan PPO/POS |
$6,357.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,710.80
|
| Rate for Payer: Three Rivers Provider Network All |
$5,298.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,216.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,766.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,569.52
|
| Rate for Payer: Zelis Auto |
$2,825.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,532.00
|
|
|
IMPLT COMPONENT FEMORAL 17 SIZE
|
Facility
|
IP
|
$7,064.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001917
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,825.60 |
| Max. Negotiated Rate |
$6,710.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,651.20
|
| Rate for Payer: Cash Price |
$4,238.40
|
| Rate for Payer: Cash Price |
$4,238.40
|
| Rate for Payer: Cigna Commercial |
$6,004.40
|
| Rate for Payer: First Health Commercial |
$6,357.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,357.60
|
| Rate for Payer: GEHA Commercial |
$4,944.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,357.60
|
| Rate for Payer: Multiplan All |
$6,428.24
|
| Rate for Payer: OMNI Networks Commercial |
$4,944.80
|
| Rate for Payer: One Health Plan PPO/POS |
$6,357.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,710.80
|
| Rate for Payer: Three Rivers Provider Network All |
$5,298.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,569.52
|
| Rate for Payer: Zelis Auto |
$2,825.60
|
|
|
IMPLT COMPONENT FEMORAL 2 RM/LL
|
Facility
|
IP
|
$6,242.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001918
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,496.80 |
| Max. Negotiated Rate |
$5,929.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,993.60
|
| Rate for Payer: Cash Price |
$3,745.20
|
| Rate for Payer: Cash Price |
$3,745.20
|
| Rate for Payer: Cigna Commercial |
$5,305.70
|
| Rate for Payer: First Health Commercial |
$5,617.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,617.80
|
| Rate for Payer: GEHA Commercial |
$4,369.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,617.80
|
| Rate for Payer: Multiplan All |
$5,680.22
|
| Rate for Payer: OMNI Networks Commercial |
$4,369.40
|
| Rate for Payer: One Health Plan PPO/POS |
$5,617.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,929.90
|
| Rate for Payer: Three Rivers Provider Network All |
$4,681.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,805.06
|
| Rate for Payer: Zelis Auto |
$2,496.80
|
|
|
IMPLT COMPONENT FEMORAL 2 RM/LL
|
Facility
|
OP
|
$6,242.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001918
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,560.50 |
| Max. Negotiated Rate |
$5,929.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,745.20
|
| Rate for Payer: Cash Price |
$3,745.20
|
| Rate for Payer: Cash Price |
$3,745.20
|
| Rate for Payer: Cigna Commercial |
$5,305.70
|
| Rate for Payer: First Health Commercial |
$5,617.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,617.80
|
| Rate for Payer: GEHA Commercial |
$4,993.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,617.80
|
| Rate for Payer: Humana ChoiceCare |
$1,622.92
|
| Rate for Payer: Multiplan All |
$5,680.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,745.20
|
| Rate for Payer: OMNI Networks Commercial |
$4,369.40
|
| Rate for Payer: One Health Plan PPO/POS |
$5,617.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,929.90
|
| Rate for Payer: Three Rivers Provider Network All |
$4,681.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,492.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,560.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,805.06
|
| Rate for Payer: Zelis Auto |
$2,496.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,121.00
|
|
|
IMPLT COMPONENT FEMORAL 2 SIZE MAKO
|
Facility
|
OP
|
$6,242.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
70001809
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,560.50 |
| Max. Negotiated Rate |
$5,929.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,745.20
|
| Rate for Payer: Cash Price |
$3,745.20
|
| Rate for Payer: Cash Price |
$3,745.20
|
| Rate for Payer: Cigna Commercial |
$5,305.70
|
| Rate for Payer: First Health Commercial |
$5,617.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,617.80
|
| Rate for Payer: GEHA Commercial |
$4,993.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,617.80
|
| Rate for Payer: Humana ChoiceCare |
$1,622.92
|
| Rate for Payer: Multiplan All |
$5,680.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,745.20
|
| Rate for Payer: OMNI Networks Commercial |
$4,369.40
|
| Rate for Payer: One Health Plan PPO/POS |
$5,617.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,929.90
|
| Rate for Payer: Three Rivers Provider Network All |
$4,681.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,492.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,560.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,805.06
|
| Rate for Payer: Zelis Auto |
$2,496.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,121.00
|
|
|
IMPLT COMPONENT FEMORAL 2 SIZE MAKO
|
Facility
|
IP
|
$6,242.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
70001809
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,496.80 |
| Max. Negotiated Rate |
$5,929.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,993.60
|
| Rate for Payer: Cash Price |
$3,745.20
|
| Rate for Payer: Cash Price |
$3,745.20
|
| Rate for Payer: Cigna Commercial |
$5,305.70
|
| Rate for Payer: First Health Commercial |
$5,617.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,617.80
|
| Rate for Payer: GEHA Commercial |
$4,369.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,617.80
|
| Rate for Payer: Multiplan All |
$5,680.22
|
| Rate for Payer: OMNI Networks Commercial |
$4,369.40
|
| Rate for Payer: One Health Plan PPO/POS |
$5,617.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,929.90
|
| Rate for Payer: Three Rivers Provider Network All |
$4,681.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,805.06
|
| Rate for Payer: Zelis Auto |
$2,496.80
|
|
|
IMPLT COMPONENT FEMORAL 3 SIZE LM/RL
|
Facility
|
OP
|
$6,242.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001919
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,560.50 |
| Max. Negotiated Rate |
$5,929.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,745.20
|
| Rate for Payer: Cash Price |
$3,745.20
|
| Rate for Payer: Cash Price |
$3,745.20
|
| Rate for Payer: Cigna Commercial |
$5,305.70
|
| Rate for Payer: First Health Commercial |
$5,617.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,617.80
|
| Rate for Payer: GEHA Commercial |
$4,993.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,617.80
|
| Rate for Payer: Humana ChoiceCare |
$1,622.92
|
| Rate for Payer: Multiplan All |
$5,680.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,745.20
|
| Rate for Payer: OMNI Networks Commercial |
$4,369.40
|
| Rate for Payer: One Health Plan PPO/POS |
$5,617.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,929.90
|
| Rate for Payer: Three Rivers Provider Network All |
$4,681.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,492.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,560.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,805.06
|
| Rate for Payer: Zelis Auto |
$2,496.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,121.00
|
|
|
IMPLT COMPONENT FEMORAL 3 SIZE LM/RL
|
Facility
|
IP
|
$6,242.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001919
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,496.80 |
| Max. Negotiated Rate |
$5,929.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,993.60
|
| Rate for Payer: Cash Price |
$3,745.20
|
| Rate for Payer: Cash Price |
$3,745.20
|
| Rate for Payer: Cigna Commercial |
$5,305.70
|
| Rate for Payer: First Health Commercial |
$5,617.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,617.80
|
| Rate for Payer: GEHA Commercial |
$4,369.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,617.80
|
| Rate for Payer: Multiplan All |
$5,680.22
|
| Rate for Payer: OMNI Networks Commercial |
$4,369.40
|
| Rate for Payer: One Health Plan PPO/POS |
$5,617.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,929.90
|
| Rate for Payer: Three Rivers Provider Network All |
$4,681.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,805.06
|
| Rate for Payer: Zelis Auto |
$2,496.80
|
|
|
IMPLT COMPONENT FEMORAL 6 SIZE LM/RL
|
Facility
|
OP
|
$6,242.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001920
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,560.50 |
| Max. Negotiated Rate |
$5,929.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,745.20
|
| Rate for Payer: Cash Price |
$3,745.20
|
| Rate for Payer: Cash Price |
$3,745.20
|
| Rate for Payer: Cigna Commercial |
$5,305.70
|
| Rate for Payer: First Health Commercial |
$5,617.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,617.80
|
| Rate for Payer: GEHA Commercial |
$4,993.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,617.80
|
| Rate for Payer: Humana ChoiceCare |
$1,622.92
|
| Rate for Payer: Multiplan All |
$5,680.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,745.20
|
| Rate for Payer: OMNI Networks Commercial |
$4,369.40
|
| Rate for Payer: One Health Plan PPO/POS |
$5,617.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,929.90
|
| Rate for Payer: Three Rivers Provider Network All |
$4,681.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,492.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,560.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,805.06
|
| Rate for Payer: Zelis Auto |
$2,496.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,121.00
|
|
|
IMPLT COMPONENT FEMORAL 6 SIZE LM/RL
|
Facility
|
IP
|
$6,242.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001920
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,496.80 |
| Max. Negotiated Rate |
$5,929.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,993.60
|
| Rate for Payer: Cash Price |
$3,745.20
|
| Rate for Payer: Cash Price |
$3,745.20
|
| Rate for Payer: Cigna Commercial |
$5,305.70
|
| Rate for Payer: First Health Commercial |
$5,617.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,617.80
|
| Rate for Payer: GEHA Commercial |
$4,369.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,617.80
|
| Rate for Payer: Multiplan All |
$5,680.22
|
| Rate for Payer: OMNI Networks Commercial |
$4,369.40
|
| Rate for Payer: One Health Plan PPO/POS |
$5,617.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,929.90
|
| Rate for Payer: Three Rivers Provider Network All |
$4,681.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,805.06
|
| Rate for Payer: Zelis Auto |
$2,496.80
|
|
|
IMPLT COMPONENT FEMORAL CONQUEST
|
Facility
|
OP
|
$5,329.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001826
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,332.25 |
| Max. Negotiated Rate |
$5,062.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,197.40
|
| Rate for Payer: Cash Price |
$3,197.40
|
| Rate for Payer: Cash Price |
$3,197.40
|
| Rate for Payer: Cigna Commercial |
$4,529.65
|
| Rate for Payer: First Health Commercial |
$4,796.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,796.10
|
| Rate for Payer: GEHA Commercial |
$4,263.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,796.10
|
| Rate for Payer: Humana ChoiceCare |
$1,385.54
|
| Rate for Payer: Multiplan All |
$4,849.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,197.40
|
| Rate for Payer: OMNI Networks Commercial |
$3,730.30
|
| Rate for Payer: One Health Plan PPO/POS |
$4,796.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,062.55
|
| Rate for Payer: Three Rivers Provider Network All |
$3,996.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,689.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,332.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,955.97
|
| Rate for Payer: Zelis Auto |
$2,131.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,664.50
|
|
|
IMPLT COMPONENT FEMORAL CONQUEST
|
Facility
|
IP
|
$5,329.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001826
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,131.60 |
| Max. Negotiated Rate |
$5,062.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,263.20
|
| Rate for Payer: Cash Price |
$3,197.40
|
| Rate for Payer: Cash Price |
$3,197.40
|
| Rate for Payer: Cigna Commercial |
$4,529.65
|
| Rate for Payer: First Health Commercial |
$4,796.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,796.10
|
| Rate for Payer: GEHA Commercial |
$3,730.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,796.10
|
| Rate for Payer: Multiplan All |
$4,849.39
|
| Rate for Payer: OMNI Networks Commercial |
$3,730.30
|
| Rate for Payer: One Health Plan PPO/POS |
$4,796.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,062.55
|
| Rate for Payer: Three Rivers Provider Network All |
$3,996.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,955.97
|
| Rate for Payer: Zelis Auto |
$2,131.60
|
|
|
IMPLT COMPONENT FEMORAL DISTAL 65MM
|
Facility
|
IP
|
$18,861.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002681
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,544.40 |
| Max. Negotiated Rate |
$17,917.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$15,088.80
|
| Rate for Payer: Cash Price |
$11,316.60
|
| Rate for Payer: Cash Price |
$11,316.60
|
| Rate for Payer: Cigna Commercial |
$16,031.85
|
| Rate for Payer: First Health Commercial |
$16,974.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$16,974.90
|
| Rate for Payer: GEHA Commercial |
$13,202.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$16,974.90
|
| Rate for Payer: Multiplan All |
$17,163.51
|
| Rate for Payer: OMNI Networks Commercial |
$13,202.70
|
| Rate for Payer: One Health Plan PPO/POS |
$16,974.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$17,917.95
|
| Rate for Payer: Three Rivers Provider Network All |
$14,145.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$17,540.73
|
| Rate for Payer: Zelis Auto |
$7,544.40
|
|
|
IMPLT COMPONENT FEMORAL DISTAL 65MM
|
Facility
|
OP
|
$18,861.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002681
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,715.25 |
| Max. Negotiated Rate |
$17,917.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$11,316.60
|
| Rate for Payer: Cash Price |
$11,316.60
|
| Rate for Payer: Cash Price |
$11,316.60
|
| Rate for Payer: Cigna Commercial |
$16,031.85
|
| Rate for Payer: First Health Commercial |
$16,974.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$16,974.90
|
| Rate for Payer: GEHA Commercial |
$15,088.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$16,974.90
|
| Rate for Payer: Humana ChoiceCare |
$4,903.86
|
| Rate for Payer: Multiplan All |
$17,163.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,316.60
|
| Rate for Payer: OMNI Networks Commercial |
$13,202.70
|
| Rate for Payer: One Health Plan PPO/POS |
$16,974.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$17,917.95
|
| Rate for Payer: Three Rivers Provider Network All |
$14,145.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16,597.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,715.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$17,540.73
|
| Rate for Payer: Zelis Auto |
$7,544.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9,430.50
|
|
|
IMPLT COMPONENT FEMORAL LARGE
|
Facility
|
OP
|
$9,896.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002728
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,474.00 |
| Max. Negotiated Rate |
$9,401.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,937.60
|
| Rate for Payer: Cash Price |
$5,937.60
|
| Rate for Payer: Cash Price |
$5,937.60
|
| Rate for Payer: Cigna Commercial |
$8,411.60
|
| Rate for Payer: First Health Commercial |
$8,906.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,906.40
|
| Rate for Payer: GEHA Commercial |
$7,916.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,906.40
|
| Rate for Payer: Humana ChoiceCare |
$2,572.96
|
| Rate for Payer: Multiplan All |
$9,005.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,937.60
|
| Rate for Payer: OMNI Networks Commercial |
$6,927.20
|
| Rate for Payer: One Health Plan PPO/POS |
$8,906.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9,401.20
|
| Rate for Payer: Three Rivers Provider Network All |
$7,422.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8,708.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,474.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9,203.28
|
| Rate for Payer: Zelis Auto |
$3,958.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,948.00
|
|
|
IMPLT COMPONENT FEMORAL LARGE
|
Facility
|
IP
|
$9,896.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002728
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,958.40 |
| Max. Negotiated Rate |
$9,401.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7,916.80
|
| Rate for Payer: Cash Price |
$5,937.60
|
| Rate for Payer: Cash Price |
$5,937.60
|
| Rate for Payer: Cigna Commercial |
$8,411.60
|
| Rate for Payer: First Health Commercial |
$8,906.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,906.40
|
| Rate for Payer: GEHA Commercial |
$6,927.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,906.40
|
| Rate for Payer: Multiplan All |
$9,005.36
|
| Rate for Payer: OMNI Networks Commercial |
$6,927.20
|
| Rate for Payer: One Health Plan PPO/POS |
$8,906.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9,401.20
|
| Rate for Payer: Three Rivers Provider Network All |
$7,422.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9,203.28
|
| Rate for Payer: Zelis Auto |
$3,958.40
|
|
|
IMPLT COMPONENT FEMORAL LARGE
|
Facility
|
IP
|
$8,374.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003265
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,349.60 |
| Max. Negotiated Rate |
$7,955.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,699.20
|
| Rate for Payer: Cash Price |
$5,024.40
|
| Rate for Payer: Cash Price |
$5,024.40
|
| Rate for Payer: Cigna Commercial |
$7,117.90
|
| Rate for Payer: First Health Commercial |
$7,536.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,536.60
|
| Rate for Payer: GEHA Commercial |
$5,861.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,536.60
|
| Rate for Payer: Multiplan All |
$7,620.34
|
| Rate for Payer: OMNI Networks Commercial |
$5,861.80
|
| Rate for Payer: One Health Plan PPO/POS |
$7,536.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,955.30
|
| Rate for Payer: Three Rivers Provider Network All |
$6,280.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,787.82
|
| Rate for Payer: Zelis Auto |
$3,349.60
|
|
|
IMPLT COMPONENT FEMORAL LARGE
|
Facility
|
OP
|
$8,374.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003265
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,093.50 |
| Max. Negotiated Rate |
$7,955.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,024.40
|
| Rate for Payer: Cash Price |
$5,024.40
|
| Rate for Payer: Cash Price |
$5,024.40
|
| Rate for Payer: Cigna Commercial |
$7,117.90
|
| Rate for Payer: First Health Commercial |
$7,536.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,536.60
|
| Rate for Payer: GEHA Commercial |
$6,699.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,536.60
|
| Rate for Payer: Humana ChoiceCare |
$2,177.24
|
| Rate for Payer: Multiplan All |
$7,620.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,024.40
|
| Rate for Payer: OMNI Networks Commercial |
$5,861.80
|
| Rate for Payer: One Health Plan PPO/POS |
$7,536.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,955.30
|
| Rate for Payer: Three Rivers Provider Network All |
$6,280.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,369.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,093.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,787.82
|
| Rate for Payer: Zelis Auto |
$3,349.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,187.00
|
|
|
IMPLT COMPONENT FEMORAL LEFT SIZE 2
|
Facility
|
OP
|
$9,896.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001921
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,474.00 |
| Max. Negotiated Rate |
$9,401.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,937.60
|
| Rate for Payer: Cash Price |
$5,937.60
|
| Rate for Payer: Cash Price |
$5,937.60
|
| Rate for Payer: Cigna Commercial |
$8,411.60
|
| Rate for Payer: First Health Commercial |
$8,906.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,906.40
|
| Rate for Payer: GEHA Commercial |
$7,916.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,906.40
|
| Rate for Payer: Humana ChoiceCare |
$2,572.96
|
| Rate for Payer: Multiplan All |
$9,005.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,937.60
|
| Rate for Payer: OMNI Networks Commercial |
$6,927.20
|
| Rate for Payer: One Health Plan PPO/POS |
$8,906.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9,401.20
|
| Rate for Payer: Three Rivers Provider Network All |
$7,422.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8,708.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,474.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9,203.28
|
| Rate for Payer: Zelis Auto |
$3,958.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,948.00
|
|
|
IMPLT COMPONENT FEMORAL LEFT SIZE 2
|
Facility
|
IP
|
$9,896.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001921
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,958.40 |
| Max. Negotiated Rate |
$9,401.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7,916.80
|
| Rate for Payer: Cash Price |
$5,937.60
|
| Rate for Payer: Cash Price |
$5,937.60
|
| Rate for Payer: Cigna Commercial |
$8,411.60
|
| Rate for Payer: First Health Commercial |
$8,906.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,906.40
|
| Rate for Payer: GEHA Commercial |
$6,927.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,906.40
|
| Rate for Payer: Multiplan All |
$9,005.36
|
| Rate for Payer: OMNI Networks Commercial |
$6,927.20
|
| Rate for Payer: One Health Plan PPO/POS |
$8,906.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9,401.20
|
| Rate for Payer: Three Rivers Provider Network All |
$7,422.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9,203.28
|
| Rate for Payer: Zelis Auto |
$3,958.40
|
|
|
IMPLT COMPONENT FEMORAL MEDIUM
|
Facility
|
IP
|
$8,374.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002726
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,349.60 |
| Max. Negotiated Rate |
$7,955.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,699.20
|
| Rate for Payer: Cash Price |
$5,024.40
|
| Rate for Payer: Cash Price |
$5,024.40
|
| Rate for Payer: Cigna Commercial |
$7,117.90
|
| Rate for Payer: First Health Commercial |
$7,536.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,536.60
|
| Rate for Payer: GEHA Commercial |
$5,861.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,536.60
|
| Rate for Payer: Multiplan All |
$7,620.34
|
| Rate for Payer: OMNI Networks Commercial |
$5,861.80
|
| Rate for Payer: One Health Plan PPO/POS |
$7,536.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,955.30
|
| Rate for Payer: Three Rivers Provider Network All |
$6,280.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,787.82
|
| Rate for Payer: Zelis Auto |
$3,349.60
|
|
|
IMPLT COMPONENT FEMORAL MEDIUM
|
Facility
|
OP
|
$8,374.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002726
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,093.50 |
| Max. Negotiated Rate |
$7,955.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,024.40
|
| Rate for Payer: Cash Price |
$5,024.40
|
| Rate for Payer: Cash Price |
$5,024.40
|
| Rate for Payer: Cigna Commercial |
$7,117.90
|
| Rate for Payer: First Health Commercial |
$7,536.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,536.60
|
| Rate for Payer: GEHA Commercial |
$6,699.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,536.60
|
| Rate for Payer: Humana ChoiceCare |
$2,177.24
|
| Rate for Payer: Multiplan All |
$7,620.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,024.40
|
| Rate for Payer: OMNI Networks Commercial |
$5,861.80
|
| Rate for Payer: One Health Plan PPO/POS |
$7,536.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,955.30
|
| Rate for Payer: Three Rivers Provider Network All |
$6,280.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,369.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,093.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,787.82
|
| Rate for Payer: Zelis Auto |
$3,349.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,187.00
|
|
|
IMPLT COMPONENT FEMORAL OFFSET HIGH
|
Facility
|
IP
|
$7,064.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001922
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,825.60 |
| Max. Negotiated Rate |
$6,710.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,651.20
|
| Rate for Payer: Cash Price |
$4,238.40
|
| Rate for Payer: Cash Price |
$4,238.40
|
| Rate for Payer: Cigna Commercial |
$6,004.40
|
| Rate for Payer: First Health Commercial |
$6,357.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,357.60
|
| Rate for Payer: GEHA Commercial |
$4,944.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,357.60
|
| Rate for Payer: Multiplan All |
$6,428.24
|
| Rate for Payer: OMNI Networks Commercial |
$4,944.80
|
| Rate for Payer: One Health Plan PPO/POS |
$6,357.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,710.80
|
| Rate for Payer: Three Rivers Provider Network All |
$5,298.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,569.52
|
| Rate for Payer: Zelis Auto |
$2,825.60
|
|
|
IMPLT COMPONENT FEMORAL OFFSET HIGH
|
Facility
|
OP
|
$7,064.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001922
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,766.00 |
| Max. Negotiated Rate |
$6,710.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,238.40
|
| Rate for Payer: Cash Price |
$4,238.40
|
| Rate for Payer: Cash Price |
$4,238.40
|
| Rate for Payer: Cigna Commercial |
$6,004.40
|
| Rate for Payer: First Health Commercial |
$6,357.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,357.60
|
| Rate for Payer: GEHA Commercial |
$5,651.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,357.60
|
| Rate for Payer: Humana ChoiceCare |
$1,836.64
|
| Rate for Payer: Multiplan All |
$6,428.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,238.40
|
| Rate for Payer: OMNI Networks Commercial |
$4,944.80
|
| Rate for Payer: One Health Plan PPO/POS |
$6,357.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,710.80
|
| Rate for Payer: Three Rivers Provider Network All |
$5,298.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,216.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,766.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,569.52
|
| Rate for Payer: Zelis Auto |
$2,825.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,532.00
|
|
