|
IMPLT COMPONENT ROTATING TIBIAL
|
Facility
|
OP
|
$8,263.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002684
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,065.75 |
| Max. Negotiated Rate |
$7,849.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,957.80
|
| Rate for Payer: Cash Price |
$4,957.80
|
| Rate for Payer: Cash Price |
$4,957.80
|
| Rate for Payer: Cigna Commercial |
$7,023.55
|
| Rate for Payer: First Health Commercial |
$7,436.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,436.70
|
| Rate for Payer: GEHA Commercial |
$6,610.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,436.70
|
| Rate for Payer: Humana ChoiceCare |
$2,148.38
|
| Rate for Payer: Multiplan All |
$7,519.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,957.80
|
| Rate for Payer: OMNI Networks Commercial |
$5,784.10
|
| Rate for Payer: One Health Plan PPO/POS |
$7,436.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,849.85
|
| Rate for Payer: Three Rivers Provider Network All |
$6,197.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,271.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,065.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,684.59
|
| Rate for Payer: Zelis Auto |
$3,305.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,131.50
|
|
|
IMPLT COMPONENT STABILIZER FEMORAL #2
|
Facility
|
IP
|
$22,510.05
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002941
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,004.02 |
| Max. Negotiated Rate |
$21,384.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$18,008.04
|
| Rate for Payer: Cash Price |
$13,506.03
|
| Rate for Payer: Cash Price |
$13,506.03
|
| Rate for Payer: Cigna Commercial |
$19,133.54
|
| Rate for Payer: First Health Commercial |
$20,259.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$20,259.04
|
| Rate for Payer: GEHA Commercial |
$15,757.03
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$20,259.04
|
| Rate for Payer: Multiplan All |
$20,484.15
|
| Rate for Payer: OMNI Networks Commercial |
$15,757.03
|
| Rate for Payer: One Health Plan PPO/POS |
$20,259.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$21,384.55
|
| Rate for Payer: Three Rivers Provider Network All |
$16,882.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$20,934.35
|
| Rate for Payer: Zelis Auto |
$9,004.02
|
|
|
IMPLT COMPONENT STABILIZER FEMORAL #2
|
Facility
|
OP
|
$22,510.05
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002941
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,627.51 |
| Max. Negotiated Rate |
$21,384.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$13,506.03
|
| Rate for Payer: Cash Price |
$13,506.03
|
| Rate for Payer: Cash Price |
$13,506.03
|
| Rate for Payer: Cigna Commercial |
$19,133.54
|
| Rate for Payer: First Health Commercial |
$20,259.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$20,259.04
|
| Rate for Payer: GEHA Commercial |
$18,008.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$20,259.04
|
| Rate for Payer: Humana ChoiceCare |
$5,852.61
|
| Rate for Payer: Multiplan All |
$20,484.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$13,506.03
|
| Rate for Payer: OMNI Networks Commercial |
$15,757.03
|
| Rate for Payer: One Health Plan PPO/POS |
$20,259.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$21,384.55
|
| Rate for Payer: Three Rivers Provider Network All |
$16,882.54
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$19,808.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,627.51
|
| Rate for Payer: United Payors & United Providers UP&UP |
$20,934.35
|
| Rate for Payer: Zelis Auto |
$9,004.02
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$11,255.02
|
|
|
IMPLT COMPONENT STABILIZER FEMORAL #3
|
Facility
|
IP
|
$17,373.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001947
|
|
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 STABILIZER FEMORAL #3
|
Facility
|
OP
|
$17,373.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001947
|
|
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 STABILIZER FEMORAL #4
|
Facility
|
IP
|
$20,487.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006146
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,194.80 |
| Max. Negotiated Rate |
$19,462.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$16,389.60
|
| Rate for Payer: Cash Price |
$12,292.20
|
| Rate for Payer: Cash Price |
$12,292.20
|
| Rate for Payer: Cigna Commercial |
$17,413.95
|
| Rate for Payer: First Health Commercial |
$18,438.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$18,438.30
|
| Rate for Payer: GEHA Commercial |
$14,340.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$18,438.30
|
| Rate for Payer: Multiplan All |
$18,643.17
|
| Rate for Payer: OMNI Networks Commercial |
$14,340.90
|
| Rate for Payer: One Health Plan PPO/POS |
$18,438.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$19,462.65
|
| Rate for Payer: Three Rivers Provider Network All |
$15,365.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$19,052.91
|
| Rate for Payer: Zelis Auto |
$8,194.80
|
|
|
IMPLT COMPONENT STABILIZER FEMORAL #4
|
Facility
|
OP
|
$20,487.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006146
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,121.75 |
| Max. Negotiated Rate |
$19,462.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$12,292.20
|
| Rate for Payer: Cash Price |
$12,292.20
|
| Rate for Payer: Cash Price |
$12,292.20
|
| Rate for Payer: Cigna Commercial |
$17,413.95
|
| Rate for Payer: First Health Commercial |
$18,438.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$18,438.30
|
| Rate for Payer: GEHA Commercial |
$16,389.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$18,438.30
|
| Rate for Payer: Humana ChoiceCare |
$5,326.62
|
| Rate for Payer: Multiplan All |
$18,643.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$12,292.20
|
| Rate for Payer: OMNI Networks Commercial |
$14,340.90
|
| Rate for Payer: One Health Plan PPO/POS |
$18,438.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$19,462.65
|
| Rate for Payer: Three Rivers Provider Network All |
$15,365.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$18,028.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,121.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$19,052.91
|
| Rate for Payer: Zelis Auto |
$8,194.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10,243.50
|
|
|
IMPLT COMPONENT STABILIZER FEMORAL SZ 3
|
Facility
|
OP
|
$17,373.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001937
|
|
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 STABILIZER FEMORAL SZ 3
|
Facility
|
IP
|
$17,373.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001937
|
|
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 STABILIZER TIBIAL #1
|
Facility
|
OP
|
$7,078.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003283
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,769.50 |
| Max. Negotiated Rate |
$6,724.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,246.80
|
| Rate for Payer: Cash Price |
$4,246.80
|
| Rate for Payer: Cash Price |
$4,246.80
|
| Rate for Payer: Cigna Commercial |
$6,016.30
|
| Rate for Payer: First Health Commercial |
$6,370.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,370.20
|
| Rate for Payer: GEHA Commercial |
$5,662.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,370.20
|
| Rate for Payer: Humana ChoiceCare |
$1,840.28
|
| Rate for Payer: Multiplan All |
$6,440.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,246.80
|
| Rate for Payer: OMNI Networks Commercial |
$4,954.60
|
| Rate for Payer: One Health Plan PPO/POS |
$6,370.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,724.10
|
| Rate for Payer: Three Rivers Provider Network All |
$5,308.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,228.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,769.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,582.54
|
| Rate for Payer: Zelis Auto |
$2,831.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,539.00
|
|
|
IMPLT COMPONENT STABILIZER TIBIAL #1
|
Facility
|
IP
|
$7,078.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003283
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,831.20 |
| Max. Negotiated Rate |
$6,724.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,662.40
|
| Rate for Payer: Cash Price |
$4,246.80
|
| Rate for Payer: Cash Price |
$4,246.80
|
| Rate for Payer: Cigna Commercial |
$6,016.30
|
| Rate for Payer: First Health Commercial |
$6,370.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,370.20
|
| Rate for Payer: GEHA Commercial |
$4,954.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,370.20
|
| Rate for Payer: Multiplan All |
$6,440.98
|
| Rate for Payer: OMNI Networks Commercial |
$4,954.60
|
| Rate for Payer: One Health Plan PPO/POS |
$6,370.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,724.10
|
| Rate for Payer: Three Rivers Provider Network All |
$5,308.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,582.54
|
| Rate for Payer: Zelis Auto |
$2,831.20
|
|
|
IMPLT COMPONENT STABILIZER TIBIAL #4
|
Facility
|
IP
|
$7,967.71
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006689
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,187.08 |
| Max. Negotiated Rate |
$7,569.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,374.17
|
| Rate for Payer: Cash Price |
$4,780.63
|
| Rate for Payer: Cash Price |
$4,780.63
|
| Rate for Payer: Cigna Commercial |
$6,772.55
|
| Rate for Payer: First Health Commercial |
$7,170.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,170.94
|
| Rate for Payer: GEHA Commercial |
$5,577.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,170.94
|
| Rate for Payer: Multiplan All |
$7,250.62
|
| Rate for Payer: OMNI Networks Commercial |
$5,577.40
|
| Rate for Payer: One Health Plan PPO/POS |
$7,170.94
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,569.32
|
| Rate for Payer: Three Rivers Provider Network All |
$5,975.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,409.97
|
| Rate for Payer: Zelis Auto |
$3,187.08
|
|
|
IMPLT COMPONENT STABILIZER TIBIAL #4
|
Facility
|
OP
|
$11,385.56
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006811
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,846.39 |
| Max. Negotiated Rate |
$10,816.28 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,831.34
|
| Rate for Payer: Cash Price |
$6,831.34
|
| Rate for Payer: Cash Price |
$6,831.34
|
| Rate for Payer: Cigna Commercial |
$9,677.73
|
| Rate for Payer: First Health Commercial |
$10,247.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10,247.00
|
| Rate for Payer: GEHA Commercial |
$9,108.45
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10,247.00
|
| Rate for Payer: Humana ChoiceCare |
$2,960.25
|
| Rate for Payer: Multiplan All |
$10,360.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6,831.34
|
| Rate for Payer: OMNI Networks Commercial |
$7,969.89
|
| Rate for Payer: One Health Plan PPO/POS |
$10,247.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10,816.28
|
| Rate for Payer: Three Rivers Provider Network All |
$8,539.17
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10,019.29
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,846.39
|
| Rate for Payer: United Payors & United Providers UP&UP |
$10,588.57
|
| Rate for Payer: Zelis Auto |
$4,554.22
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,692.78
|
|
|
IMPLT COMPONENT STABILIZER TIBIAL #4
|
Facility
|
IP
|
$11,385.56
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006811
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,554.22 |
| Max. Negotiated Rate |
$10,816.28 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9,108.45
|
| Rate for Payer: Cash Price |
$6,831.34
|
| Rate for Payer: Cash Price |
$6,831.34
|
| Rate for Payer: Cigna Commercial |
$9,677.73
|
| Rate for Payer: First Health Commercial |
$10,247.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10,247.00
|
| Rate for Payer: GEHA Commercial |
$7,969.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10,247.00
|
| Rate for Payer: Multiplan All |
$10,360.86
|
| Rate for Payer: OMNI Networks Commercial |
$7,969.89
|
| Rate for Payer: One Health Plan PPO/POS |
$10,247.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10,816.28
|
| Rate for Payer: Three Rivers Provider Network All |
$8,539.17
|
| Rate for Payer: United Payors & United Providers UP&UP |
$10,588.57
|
| Rate for Payer: Zelis Auto |
$4,554.22
|
|
|
IMPLT COMPONENT STABILIZER TIBIAL #4
|
Facility
|
OP
|
$7,967.71
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006689
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,991.93 |
| Max. Negotiated Rate |
$7,569.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,780.63
|
| Rate for Payer: Cash Price |
$4,780.63
|
| Rate for Payer: Cash Price |
$4,780.63
|
| Rate for Payer: Cigna Commercial |
$6,772.55
|
| Rate for Payer: First Health Commercial |
$7,170.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,170.94
|
| Rate for Payer: GEHA Commercial |
$6,374.17
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,170.94
|
| Rate for Payer: Humana ChoiceCare |
$2,071.60
|
| Rate for Payer: Multiplan All |
$7,250.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,780.63
|
| Rate for Payer: OMNI Networks Commercial |
$5,577.40
|
| Rate for Payer: One Health Plan PPO/POS |
$7,170.94
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,569.32
|
| Rate for Payer: Three Rivers Provider Network All |
$5,975.78
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,011.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,991.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,409.97
|
| Rate for Payer: Zelis Auto |
$3,187.08
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,983.86
|
|
|
IMPLT COMPONENT TIBIAL 3 SIZE
|
Facility
|
OP
|
$6,437.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002730
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,609.25 |
| Max. Negotiated Rate |
$6,115.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,862.20
|
| Rate for Payer: Cash Price |
$3,862.20
|
| Rate for Payer: Cash Price |
$3,862.20
|
| Rate for Payer: Cigna Commercial |
$5,471.45
|
| Rate for Payer: First Health Commercial |
$5,793.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,793.30
|
| Rate for Payer: GEHA Commercial |
$5,149.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,793.30
|
| Rate for Payer: Humana ChoiceCare |
$1,673.62
|
| Rate for Payer: Multiplan All |
$5,857.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,862.20
|
| Rate for Payer: OMNI Networks Commercial |
$4,505.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,793.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,115.15
|
| Rate for Payer: Three Rivers Provider Network All |
$4,827.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,664.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,609.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,986.41
|
| Rate for Payer: Zelis Auto |
$2,574.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,218.50
|
|
|
IMPLT COMPONENT TIBIAL 3 SIZE
|
Facility
|
IP
|
$6,437.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002730
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,574.80 |
| Max. Negotiated Rate |
$6,115.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,149.60
|
| Rate for Payer: Cash Price |
$3,862.20
|
| Rate for Payer: Cash Price |
$3,862.20
|
| Rate for Payer: Cigna Commercial |
$5,471.45
|
| Rate for Payer: First Health Commercial |
$5,793.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,793.30
|
| Rate for Payer: GEHA Commercial |
$4,505.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,793.30
|
| Rate for Payer: Multiplan All |
$5,857.67
|
| Rate for Payer: OMNI Networks Commercial |
$4,505.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,793.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,115.15
|
| Rate for Payer: Three Rivers Provider Network All |
$4,827.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,986.41
|
| Rate for Payer: Zelis Auto |
$2,574.80
|
|
|
IMPLT COMPONENT TIBIAL 8 SIZE
|
Facility
|
IP
|
$5,329.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002747
|
|
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 TIBIAL 8 SIZE
|
Facility
|
OP
|
$5,329.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002747
|
|
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 TIBIAL LARGE
|
Facility
|
OP
|
$6,851.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002727
|
|
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 COMPONENT TIBIAL LARGE
|
Facility
|
IP
|
$6,851.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002727
|
|
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 COMPONENT TIBIAL MEDIUM
|
Facility
|
OP
|
$6,851.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002725
|
|
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 COMPONENT TIBIAL MEDIUM
|
Facility
|
IP
|
$6,851.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002725
|
|
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 COMPONENT TIBIAL SIZE 6
|
Facility
|
IP
|
$6,437.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006560
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,574.80 |
| Max. Negotiated Rate |
$6,115.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,149.60
|
| Rate for Payer: Cash Price |
$3,862.20
|
| Rate for Payer: Cash Price |
$3,862.20
|
| Rate for Payer: Cigna Commercial |
$5,471.45
|
| Rate for Payer: First Health Commercial |
$5,793.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,793.30
|
| Rate for Payer: GEHA Commercial |
$4,505.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,793.30
|
| Rate for Payer: Multiplan All |
$5,857.67
|
| Rate for Payer: OMNI Networks Commercial |
$4,505.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,793.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,115.15
|
| Rate for Payer: Three Rivers Provider Network All |
$4,827.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,986.41
|
| Rate for Payer: Zelis Auto |
$2,574.80
|
|
|
IMPLT COMPONENT TIBIAL SIZE 6
|
Facility
|
OP
|
$6,437.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006560
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,609.25 |
| Max. Negotiated Rate |
$6,115.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,862.20
|
| Rate for Payer: Cash Price |
$3,862.20
|
| Rate for Payer: Cash Price |
$3,862.20
|
| Rate for Payer: Cigna Commercial |
$5,471.45
|
| Rate for Payer: First Health Commercial |
$5,793.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,793.30
|
| Rate for Payer: GEHA Commercial |
$5,149.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,793.30
|
| Rate for Payer: Humana ChoiceCare |
$1,673.62
|
| Rate for Payer: Multiplan All |
$5,857.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,862.20
|
| Rate for Payer: OMNI Networks Commercial |
$4,505.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,793.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,115.15
|
| Rate for Payer: Three Rivers Provider Network All |
$4,827.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,664.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,609.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,986.41
|
| Rate for Payer: Zelis Auto |
$2,574.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,218.50
|
|
