|
IMPLT COMPONENT FEMORAL SIZE 6 RM/LL
|
Facility
|
OP
|
$6,242.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001930
|
|
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 SIZE 6 RM/LL
|
Facility
|
IP
|
$6,242.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001930
|
|
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 SIZE 7
|
Facility
|
OP
|
$6,242.00
|
|
| Hospital Charge Code |
7002650
|
|
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 SIZE 7
|
Facility
|
IP
|
$6,242.00
|
|
| Hospital Charge Code |
7002650
|
|
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 SIZE 7 RM/LL
|
Facility
|
OP
|
$6,242.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003278
|
|
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 SIZE 7 RM/LL
|
Facility
|
IP
|
$6,242.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003278
|
|
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 SIZE 9
|
Facility
|
OP
|
$7,064.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001831
|
|
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 SIZE 9
|
Facility
|
IP
|
$7,064.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001831
|
|
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 STAB #6 LFT TS
|
Facility
|
IP
|
$18,037.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002956
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,214.80 |
| Max. Negotiated Rate |
$17,135.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$14,429.60
|
| Rate for Payer: Cash Price |
$10,822.20
|
| Rate for Payer: Cash Price |
$10,822.20
|
| Rate for Payer: Cigna Commercial |
$15,331.45
|
| Rate for Payer: First Health Commercial |
$16,233.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$16,233.30
|
| Rate for Payer: GEHA Commercial |
$12,625.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$16,233.30
|
| Rate for Payer: Multiplan All |
$16,413.67
|
| Rate for Payer: OMNI Networks Commercial |
$12,625.90
|
| Rate for Payer: One Health Plan PPO/POS |
$16,233.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$17,135.15
|
| Rate for Payer: Three Rivers Provider Network All |
$13,527.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$16,774.41
|
| Rate for Payer: Zelis Auto |
$7,214.80
|
|
|
IMPLT COMPONENT FEMORAL STAB #6 LFT TS
|
Facility
|
OP
|
$18,037.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002956
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,509.25 |
| Max. Negotiated Rate |
$17,135.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$10,822.20
|
| Rate for Payer: Cash Price |
$10,822.20
|
| Rate for Payer: Cash Price |
$10,822.20
|
| Rate for Payer: Cigna Commercial |
$15,331.45
|
| Rate for Payer: First Health Commercial |
$16,233.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$16,233.30
|
| Rate for Payer: GEHA Commercial |
$14,429.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$16,233.30
|
| Rate for Payer: Humana ChoiceCare |
$4,689.62
|
| Rate for Payer: Multiplan All |
$16,413.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10,822.20
|
| Rate for Payer: OMNI Networks Commercial |
$12,625.90
|
| Rate for Payer: One Health Plan PPO/POS |
$16,233.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$17,135.15
|
| Rate for Payer: Three Rivers Provider Network All |
$13,527.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$15,872.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,509.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$16,774.41
|
| Rate for Payer: Zelis Auto |
$7,214.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9,018.50
|
|
|
IMPLT COMPONENT FEMORAL STAB #6 RT TS
|
Facility
|
OP
|
$18,037.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001932
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,509.25 |
| Max. Negotiated Rate |
$17,135.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$10,822.20
|
| Rate for Payer: Cash Price |
$10,822.20
|
| Rate for Payer: Cash Price |
$10,822.20
|
| Rate for Payer: Cigna Commercial |
$15,331.45
|
| Rate for Payer: First Health Commercial |
$16,233.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$16,233.30
|
| Rate for Payer: GEHA Commercial |
$14,429.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$16,233.30
|
| Rate for Payer: Humana ChoiceCare |
$4,689.62
|
| Rate for Payer: Multiplan All |
$16,413.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10,822.20
|
| Rate for Payer: OMNI Networks Commercial |
$12,625.90
|
| Rate for Payer: One Health Plan PPO/POS |
$16,233.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$17,135.15
|
| Rate for Payer: Three Rivers Provider Network All |
$13,527.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$15,872.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,509.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$16,774.41
|
| Rate for Payer: Zelis Auto |
$7,214.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9,018.50
|
|
|
IMPLT COMPONENT FEMORAL STAB #6 RT TS
|
Facility
|
IP
|
$18,037.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001932
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,214.80 |
| Max. Negotiated Rate |
$17,135.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$14,429.60
|
| Rate for Payer: Cash Price |
$10,822.20
|
| Rate for Payer: Cash Price |
$10,822.20
|
| Rate for Payer: Cigna Commercial |
$15,331.45
|
| Rate for Payer: First Health Commercial |
$16,233.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$16,233.30
|
| Rate for Payer: GEHA Commercial |
$12,625.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$16,233.30
|
| Rate for Payer: Multiplan All |
$16,413.67
|
| Rate for Payer: OMNI Networks Commercial |
$12,625.90
|
| Rate for Payer: One Health Plan PPO/POS |
$16,233.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$17,135.15
|
| Rate for Payer: Three Rivers Provider Network All |
$13,527.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$16,774.41
|
| Rate for Payer: Zelis Auto |
$7,214.80
|
|
|
IMPLT COMPONENT FEMORAL STABILIZED #5
|
Facility
|
OP
|
$17,409.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006205
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,352.25 |
| Max. Negotiated Rate |
$16,538.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$10,445.40
|
| Rate for Payer: Cash Price |
$10,445.40
|
| Rate for Payer: Cash Price |
$10,445.40
|
| Rate for Payer: Cigna Commercial |
$14,797.65
|
| Rate for Payer: First Health Commercial |
$15,668.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$15,668.10
|
| Rate for Payer: GEHA Commercial |
$13,927.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$15,668.10
|
| Rate for Payer: Humana ChoiceCare |
$4,526.34
|
| Rate for Payer: Multiplan All |
$15,842.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10,445.40
|
| Rate for Payer: OMNI Networks Commercial |
$12,186.30
|
| Rate for Payer: One Health Plan PPO/POS |
$15,668.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$16,538.55
|
| Rate for Payer: Three Rivers Provider Network All |
$13,056.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$15,319.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,352.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$16,190.37
|
| Rate for Payer: Zelis Auto |
$6,963.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,704.50
|
|
|
IMPLT COMPONENT FEMORAL STABILIZED #5
|
Facility
|
IP
|
$17,409.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006205
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,963.60 |
| Max. Negotiated Rate |
$16,538.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$13,927.20
|
| Rate for Payer: Cash Price |
$10,445.40
|
| Rate for Payer: Cash Price |
$10,445.40
|
| Rate for Payer: Cigna Commercial |
$14,797.65
|
| Rate for Payer: First Health Commercial |
$15,668.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$15,668.10
|
| Rate for Payer: GEHA Commercial |
$12,186.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$15,668.10
|
| Rate for Payer: Multiplan All |
$15,842.19
|
| Rate for Payer: OMNI Networks Commercial |
$12,186.30
|
| Rate for Payer: One Health Plan PPO/POS |
$15,668.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$16,538.55
|
| Rate for Payer: Three Rivers Provider Network All |
$13,056.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$16,190.37
|
| Rate for Payer: Zelis Auto |
$6,963.60
|
|
|
IMPLT COMPONENT FEMORAL STABILIZED SIZE3
|
Facility
|
OP
|
$7,552.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001931
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,888.00 |
| Max. Negotiated Rate |
$7,174.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,531.20
|
| Rate for Payer: Cash Price |
$4,531.20
|
| Rate for Payer: Cash Price |
$4,531.20
|
| Rate for Payer: Cigna Commercial |
$6,419.20
|
| Rate for Payer: First Health Commercial |
$6,796.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,796.80
|
| Rate for Payer: GEHA Commercial |
$6,041.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,796.80
|
| Rate for Payer: Humana ChoiceCare |
$1,963.52
|
| Rate for Payer: Multiplan All |
$6,872.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,531.20
|
| Rate for Payer: OMNI Networks Commercial |
$5,286.40
|
| Rate for Payer: One Health Plan PPO/POS |
$6,796.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,174.40
|
| Rate for Payer: Three Rivers Provider Network All |
$5,664.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,645.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,888.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,023.36
|
| Rate for Payer: Zelis Auto |
$3,020.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,776.00
|
|
|
IMPLT COMPONENT FEMORAL STABILIZED SIZE3
|
Facility
|
IP
|
$7,552.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001931
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,020.80 |
| Max. Negotiated Rate |
$7,174.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,041.60
|
| Rate for Payer: Cash Price |
$4,531.20
|
| Rate for Payer: Cash Price |
$4,531.20
|
| Rate for Payer: Cigna Commercial |
$6,419.20
|
| Rate for Payer: First Health Commercial |
$6,796.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,796.80
|
| Rate for Payer: GEHA Commercial |
$5,286.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,796.80
|
| Rate for Payer: Multiplan All |
$6,872.32
|
| Rate for Payer: OMNI Networks Commercial |
$5,286.40
|
| Rate for Payer: One Health Plan PPO/POS |
$6,796.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,174.40
|
| Rate for Payer: Three Rivers Provider Network All |
$5,664.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,023.36
|
| Rate for Payer: Zelis Auto |
$3,020.80
|
|
|
IMPLT COMPONENT FEMORAL STABILIZER #7
|
Facility
|
IP
|
$17,373.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002643
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,949.20 |
| Max. Negotiated Rate |
$16,504.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$13,898.40
|
| Rate for Payer: Cash Price |
$10,423.80
|
| Rate for Payer: Cash Price |
$10,423.80
|
| Rate for Payer: Cigna Commercial |
$14,767.05
|
| Rate for Payer: First Health Commercial |
$15,635.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$15,635.70
|
| Rate for Payer: GEHA Commercial |
$12,161.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$15,635.70
|
| Rate for Payer: Multiplan All |
$15,809.43
|
| Rate for Payer: OMNI Networks Commercial |
$12,161.10
|
| Rate for Payer: One Health Plan PPO/POS |
$15,635.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$16,504.35
|
| Rate for Payer: Three Rivers Provider Network All |
$13,029.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$16,156.89
|
| Rate for Payer: Zelis Auto |
$6,949.20
|
|
|
IMPLT COMPONENT FEMORAL STABILIZER #7
|
Facility
|
OP
|
$17,373.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002643
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,343.25 |
| Max. Negotiated Rate |
$16,504.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$10,423.80
|
| Rate for Payer: Cash Price |
$10,423.80
|
| Rate for Payer: Cash Price |
$10,423.80
|
| Rate for Payer: Cigna Commercial |
$14,767.05
|
| Rate for Payer: First Health Commercial |
$15,635.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$15,635.70
|
| Rate for Payer: GEHA Commercial |
$13,898.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$15,635.70
|
| Rate for Payer: Humana ChoiceCare |
$4,516.98
|
| Rate for Payer: Multiplan All |
$15,809.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10,423.80
|
| Rate for Payer: OMNI Networks Commercial |
$12,161.10
|
| Rate for Payer: One Health Plan PPO/POS |
$15,635.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$16,504.35
|
| Rate for Payer: Three Rivers Provider Network All |
$13,029.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$15,288.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,343.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$16,156.89
|
| Rate for Payer: Zelis Auto |
$6,949.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,686.50
|
|
|
IMPLT COMPONENT FEMORAL STABILIZER SZ5
|
Facility
|
IP
|
$18,037.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001933
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,214.80 |
| Max. Negotiated Rate |
$17,135.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$14,429.60
|
| Rate for Payer: Cash Price |
$10,822.20
|
| Rate for Payer: Cash Price |
$10,822.20
|
| Rate for Payer: Cigna Commercial |
$15,331.45
|
| Rate for Payer: First Health Commercial |
$16,233.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$16,233.30
|
| Rate for Payer: GEHA Commercial |
$12,625.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$16,233.30
|
| Rate for Payer: Multiplan All |
$16,413.67
|
| Rate for Payer: OMNI Networks Commercial |
$12,625.90
|
| Rate for Payer: One Health Plan PPO/POS |
$16,233.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$17,135.15
|
| Rate for Payer: Three Rivers Provider Network All |
$13,527.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$16,774.41
|
| Rate for Payer: Zelis Auto |
$7,214.80
|
|
|
IMPLT COMPONENT FEMORAL STABILIZER SZ5
|
Facility
|
OP
|
$18,037.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001933
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,509.25 |
| Max. Negotiated Rate |
$17,135.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$10,822.20
|
| Rate for Payer: Cash Price |
$10,822.20
|
| Rate for Payer: Cash Price |
$10,822.20
|
| Rate for Payer: Cigna Commercial |
$15,331.45
|
| Rate for Payer: First Health Commercial |
$16,233.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$16,233.30
|
| Rate for Payer: GEHA Commercial |
$14,429.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$16,233.30
|
| Rate for Payer: Humana ChoiceCare |
$4,689.62
|
| Rate for Payer: Multiplan All |
$16,413.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10,822.20
|
| Rate for Payer: OMNI Networks Commercial |
$12,625.90
|
| Rate for Payer: One Health Plan PPO/POS |
$16,233.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$17,135.15
|
| Rate for Payer: Three Rivers Provider Network All |
$13,527.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$15,872.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,509.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$16,774.41
|
| Rate for Payer: Zelis Auto |
$7,214.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9,018.50
|
|
|
IMPLT COMPONENT FEMORAL SZ3
|
Facility
|
OP
|
$6,106.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001943
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,526.50 |
| Max. Negotiated Rate |
$5,800.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,663.60
|
| Rate for Payer: Cash Price |
$3,663.60
|
| Rate for Payer: Cash Price |
$3,663.60
|
| Rate for Payer: Cigna Commercial |
$5,190.10
|
| Rate for Payer: First Health Commercial |
$5,495.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,495.40
|
| Rate for Payer: GEHA Commercial |
$4,884.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,495.40
|
| Rate for Payer: Humana ChoiceCare |
$1,587.56
|
| Rate for Payer: Multiplan All |
$5,556.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,663.60
|
| Rate for Payer: OMNI Networks Commercial |
$4,274.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5,495.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,800.70
|
| Rate for Payer: Three Rivers Provider Network All |
$4,579.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,373.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,526.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,678.58
|
| Rate for Payer: Zelis Auto |
$2,442.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,053.00
|
|
|
IMPLT COMPONENT FEMORAL SZ3
|
Facility
|
IP
|
$6,106.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001943
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,442.40 |
| Max. Negotiated Rate |
$5,800.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,884.80
|
| Rate for Payer: Cash Price |
$3,663.60
|
| Rate for Payer: Cash Price |
$3,663.60
|
| Rate for Payer: Cigna Commercial |
$5,190.10
|
| Rate for Payer: First Health Commercial |
$5,495.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,495.40
|
| Rate for Payer: GEHA Commercial |
$4,274.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,495.40
|
| Rate for Payer: Multiplan All |
$5,556.46
|
| Rate for Payer: OMNI Networks Commercial |
$4,274.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5,495.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,800.70
|
| Rate for Payer: Three Rivers Provider Network All |
$4,579.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,678.58
|
| Rate for Payer: Zelis Auto |
$2,442.40
|
|
|
IMPLT COMPONENT FEMORAL SZ4
|
Facility
|
OP
|
$6,105.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001944
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,526.25 |
| Max. Negotiated Rate |
$5,799.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,663.00
|
| Rate for Payer: Cash Price |
$3,663.00
|
| Rate for Payer: Cash Price |
$3,663.00
|
| Rate for Payer: Cigna Commercial |
$5,189.25
|
| Rate for Payer: First Health Commercial |
$5,494.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,494.50
|
| Rate for Payer: GEHA Commercial |
$4,884.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,494.50
|
| Rate for Payer: Humana ChoiceCare |
$1,587.30
|
| Rate for Payer: Multiplan All |
$5,555.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,663.00
|
| Rate for Payer: OMNI Networks Commercial |
$4,273.50
|
| Rate for Payer: One Health Plan PPO/POS |
$5,494.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,799.75
|
| Rate for Payer: Three Rivers Provider Network All |
$4,578.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,372.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,526.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,677.65
|
| Rate for Payer: Zelis Auto |
$2,442.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,052.50
|
|
|
IMPLT COMPONENT FEMORAL SZ4
|
Facility
|
IP
|
$6,105.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001944
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,442.00 |
| Max. Negotiated Rate |
$5,799.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,884.00
|
| Rate for Payer: Cash Price |
$3,663.00
|
| Rate for Payer: Cash Price |
$3,663.00
|
| Rate for Payer: Cigna Commercial |
$5,189.25
|
| Rate for Payer: First Health Commercial |
$5,494.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,494.50
|
| Rate for Payer: GEHA Commercial |
$4,273.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,494.50
|
| Rate for Payer: Multiplan All |
$5,555.55
|
| Rate for Payer: OMNI Networks Commercial |
$4,273.50
|
| Rate for Payer: One Health Plan PPO/POS |
$5,494.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,799.75
|
| Rate for Payer: Three Rivers Provider Network All |
$4,578.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,677.65
|
| Rate for Payer: Zelis Auto |
$2,442.00
|
|
|
IMPLT COMPONENT FEMORAL SZ5
|
Facility
|
OP
|
$883.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001945
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.75 |
| Max. Negotiated Rate |
$838.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$529.80
|
| Rate for Payer: Cash Price |
$529.80
|
| Rate for Payer: Cash Price |
$529.80
|
| Rate for Payer: Cigna Commercial |
$750.55
|
| Rate for Payer: First Health Commercial |
$794.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$794.70
|
| Rate for Payer: GEHA Commercial |
$706.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$794.70
|
| Rate for Payer: Humana ChoiceCare |
$229.58
|
| Rate for Payer: Multiplan All |
$803.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$529.80
|
| Rate for Payer: OMNI Networks Commercial |
$618.10
|
| Rate for Payer: One Health Plan PPO/POS |
$794.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$838.85
|
| Rate for Payer: Three Rivers Provider Network All |
$662.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$777.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$220.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$821.19
|
| Rate for Payer: Zelis Auto |
$353.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$441.50
|
|
