|
IMPLT CUBES CANCELLOUS 7MM 30CC
|
Facility
|
OP
|
$2,243.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003254
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$560.75 |
| Max. Negotiated Rate |
$2,130.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,345.80
|
| Rate for Payer: Cash Price |
$1,345.80
|
| Rate for Payer: Cash Price |
$1,345.80
|
| Rate for Payer: Cigna Commercial |
$1,906.55
|
| Rate for Payer: First Health Commercial |
$2,018.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,018.70
|
| Rate for Payer: GEHA Commercial |
$1,794.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,018.70
|
| Rate for Payer: Humana ChoiceCare |
$583.18
|
| Rate for Payer: Multiplan All |
$2,041.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,345.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,570.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,018.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,130.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,682.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,973.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$560.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,085.99
|
| Rate for Payer: Zelis Auto |
$897.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,121.50
|
|
|
IMPLT CUBES CANCELLOUS 7MM 30CC
|
Facility
|
IP
|
$2,243.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003254
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.20 |
| Max. Negotiated Rate |
$2,130.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,794.40
|
| Rate for Payer: Cash Price |
$1,345.80
|
| Rate for Payer: Cash Price |
$1,345.80
|
| Rate for Payer: Cigna Commercial |
$1,906.55
|
| Rate for Payer: First Health Commercial |
$2,018.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,018.70
|
| Rate for Payer: GEHA Commercial |
$1,570.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,018.70
|
| Rate for Payer: Multiplan All |
$2,041.13
|
| Rate for Payer: OMNI Networks Commercial |
$1,570.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,018.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,130.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,682.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,085.99
|
| Rate for Payer: Zelis Auto |
$897.20
|
|
|
IMPLT CUFF WITH IZ AMS 800
|
Facility
|
IP
|
$17,984.00
|
|
|
Service Code
|
CPT C1813
|
| Hospital Charge Code |
7002477
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,193.60 |
| Max. Negotiated Rate |
$17,084.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$14,387.20
|
| Rate for Payer: Cash Price |
$10,790.40
|
| Rate for Payer: Cash Price |
$10,790.40
|
| Rate for Payer: Cigna Commercial |
$15,286.40
|
| Rate for Payer: First Health Commercial |
$16,185.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$16,185.60
|
| Rate for Payer: GEHA Commercial |
$12,588.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$16,185.60
|
| Rate for Payer: Multiplan All |
$16,365.44
|
| Rate for Payer: OMNI Networks Commercial |
$12,588.80
|
| Rate for Payer: One Health Plan PPO/POS |
$16,185.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$17,084.80
|
| Rate for Payer: Three Rivers Provider Network All |
$13,488.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$16,725.12
|
| Rate for Payer: Zelis Auto |
$7,193.60
|
|
|
IMPLT CUFF WITH IZ AMS 800
|
Facility
|
OP
|
$17,984.00
|
|
|
Service Code
|
CPT C1813
|
| Hospital Charge Code |
7002477
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,496.00 |
| Max. Negotiated Rate |
$17,084.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$10,790.40
|
| Rate for Payer: Cash Price |
$10,790.40
|
| Rate for Payer: Cash Price |
$10,790.40
|
| Rate for Payer: Cigna Commercial |
$15,286.40
|
| Rate for Payer: First Health Commercial |
$16,185.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$16,185.60
|
| Rate for Payer: GEHA Commercial |
$14,387.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$16,185.60
|
| Rate for Payer: Humana ChoiceCare |
$4,675.84
|
| Rate for Payer: Multiplan All |
$16,365.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10,790.40
|
| Rate for Payer: OMNI Networks Commercial |
$12,588.80
|
| Rate for Payer: One Health Plan PPO/POS |
$16,185.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$17,084.80
|
| Rate for Payer: Three Rivers Provider Network All |
$13,488.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$15,825.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,496.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$16,725.12
|
| Rate for Payer: Zelis Auto |
$7,193.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,992.00
|
|
|
IMPLT CUP ACETABULAR 60MM RINGLOC
|
Facility
|
IP
|
$4,744.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001969
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,897.60 |
| Max. Negotiated Rate |
$4,506.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,795.20
|
| Rate for Payer: Cash Price |
$2,846.40
|
| Rate for Payer: Cash Price |
$2,846.40
|
| Rate for Payer: Cigna Commercial |
$4,032.40
|
| Rate for Payer: First Health Commercial |
$4,269.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,269.60
|
| Rate for Payer: GEHA Commercial |
$3,320.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,269.60
|
| Rate for Payer: Multiplan All |
$4,317.04
|
| Rate for Payer: OMNI Networks Commercial |
$3,320.80
|
| Rate for Payer: One Health Plan PPO/POS |
$4,269.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,506.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3,558.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,411.92
|
| Rate for Payer: Zelis Auto |
$1,897.60
|
|
|
IMPLT CUP ACETABULAR 60MM RINGLOC
|
Facility
|
OP
|
$4,744.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001969
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,186.00 |
| Max. Negotiated Rate |
$4,506.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,846.40
|
| Rate for Payer: Cash Price |
$2,846.40
|
| Rate for Payer: Cash Price |
$2,846.40
|
| Rate for Payer: Cigna Commercial |
$4,032.40
|
| Rate for Payer: First Health Commercial |
$4,269.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,269.60
|
| Rate for Payer: GEHA Commercial |
$3,795.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,269.60
|
| Rate for Payer: Humana ChoiceCare |
$1,233.44
|
| Rate for Payer: Multiplan All |
$4,317.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,846.40
|
| Rate for Payer: OMNI Networks Commercial |
$3,320.80
|
| Rate for Payer: One Health Plan PPO/POS |
$4,269.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,506.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3,558.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,174.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,186.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,411.92
|
| Rate for Payer: Zelis Auto |
$1,897.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,372.00
|
|
|
IMPLT CUP ACETABULAR REGENEREX 52MM
|
Facility
|
OP
|
$1,342.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001837
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$335.50 |
| Max. Negotiated Rate |
$1,274.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$805.20
|
| Rate for Payer: Cash Price |
$805.20
|
| Rate for Payer: Cash Price |
$805.20
|
| Rate for Payer: Cigna Commercial |
$1,140.70
|
| Rate for Payer: First Health Commercial |
$1,207.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,207.80
|
| Rate for Payer: GEHA Commercial |
$1,073.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,207.80
|
| Rate for Payer: Humana ChoiceCare |
$348.92
|
| Rate for Payer: Multiplan All |
$1,221.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$805.20
|
| Rate for Payer: OMNI Networks Commercial |
$939.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,207.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,274.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,006.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,180.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$335.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,248.06
|
| Rate for Payer: Zelis Auto |
$536.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$671.00
|
|
|
IMPLT CUP ACETABULAR REGENEREX 52MM
|
Facility
|
IP
|
$1,342.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001837
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$536.80 |
| Max. Negotiated Rate |
$1,274.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,073.60
|
| Rate for Payer: Cash Price |
$805.20
|
| Rate for Payer: Cash Price |
$805.20
|
| Rate for Payer: Cigna Commercial |
$1,140.70
|
| Rate for Payer: First Health Commercial |
$1,207.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,207.80
|
| Rate for Payer: GEHA Commercial |
$939.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,207.80
|
| Rate for Payer: Multiplan All |
$1,221.22
|
| Rate for Payer: OMNI Networks Commercial |
$939.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,207.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,274.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,006.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,248.06
|
| Rate for Payer: Zelis Auto |
$536.80
|
|
|
IMPLT CUP ACETABULAR REGENEREX 54MM
|
Facility
|
IP
|
$4,744.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001839
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,897.60 |
| Max. Negotiated Rate |
$4,506.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,795.20
|
| Rate for Payer: Cash Price |
$2,846.40
|
| Rate for Payer: Cash Price |
$2,846.40
|
| Rate for Payer: Cigna Commercial |
$4,032.40
|
| Rate for Payer: First Health Commercial |
$4,269.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,269.60
|
| Rate for Payer: GEHA Commercial |
$3,320.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,269.60
|
| Rate for Payer: Multiplan All |
$4,317.04
|
| Rate for Payer: OMNI Networks Commercial |
$3,320.80
|
| Rate for Payer: One Health Plan PPO/POS |
$4,269.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,506.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3,558.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,411.92
|
| Rate for Payer: Zelis Auto |
$1,897.60
|
|
|
IMPLT CUP ACETABULAR REGENEREX 54MM
|
Facility
|
OP
|
$4,744.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001839
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,186.00 |
| Max. Negotiated Rate |
$4,506.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,846.40
|
| Rate for Payer: Cash Price |
$2,846.40
|
| Rate for Payer: Cash Price |
$2,846.40
|
| Rate for Payer: Cigna Commercial |
$4,032.40
|
| Rate for Payer: First Health Commercial |
$4,269.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,269.60
|
| Rate for Payer: GEHA Commercial |
$3,795.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,269.60
|
| Rate for Payer: Humana ChoiceCare |
$1,233.44
|
| Rate for Payer: Multiplan All |
$4,317.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,846.40
|
| Rate for Payer: OMNI Networks Commercial |
$3,320.80
|
| Rate for Payer: One Health Plan PPO/POS |
$4,269.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,506.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3,558.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,174.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,186.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,411.92
|
| Rate for Payer: Zelis Auto |
$1,897.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,372.00
|
|
|
IMPLT CUP ACETABULAR REGENEREX 56MM
|
Facility
|
IP
|
$8,346.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001836
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,338.40 |
| Max. Negotiated Rate |
$7,928.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,676.80
|
| Rate for Payer: Cash Price |
$5,007.60
|
| Rate for Payer: Cash Price |
$5,007.60
|
| Rate for Payer: Cigna Commercial |
$7,094.10
|
| Rate for Payer: First Health Commercial |
$7,511.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,511.40
|
| Rate for Payer: GEHA Commercial |
$5,842.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,511.40
|
| Rate for Payer: Multiplan All |
$7,594.86
|
| Rate for Payer: OMNI Networks Commercial |
$5,842.20
|
| Rate for Payer: One Health Plan PPO/POS |
$7,511.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,928.70
|
| Rate for Payer: Three Rivers Provider Network All |
$6,259.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,761.78
|
| Rate for Payer: Zelis Auto |
$3,338.40
|
|
|
IMPLT CUP ACETABULAR REGENEREX 56MM
|
Facility
|
OP
|
$8,346.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001836
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,086.50 |
| Max. Negotiated Rate |
$7,928.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,007.60
|
| Rate for Payer: Cash Price |
$5,007.60
|
| Rate for Payer: Cash Price |
$5,007.60
|
| Rate for Payer: Cigna Commercial |
$7,094.10
|
| Rate for Payer: First Health Commercial |
$7,511.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,511.40
|
| Rate for Payer: GEHA Commercial |
$6,676.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,511.40
|
| Rate for Payer: Humana ChoiceCare |
$2,169.96
|
| Rate for Payer: Multiplan All |
$7,594.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,007.60
|
| Rate for Payer: OMNI Networks Commercial |
$5,842.20
|
| Rate for Payer: One Health Plan PPO/POS |
$7,511.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,928.70
|
| Rate for Payer: Three Rivers Provider Network All |
$6,259.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,344.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,086.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,761.78
|
| Rate for Payer: Zelis Auto |
$3,338.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,173.00
|
|
|
IMPLT CUP ACETABULAR REGENEREX 60MM
|
Facility
|
OP
|
$7,110.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001838
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,777.50 |
| Max. Negotiated Rate |
$6,754.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,266.00
|
| Rate for Payer: Cash Price |
$4,266.00
|
| Rate for Payer: Cash Price |
$4,266.00
|
| Rate for Payer: Cigna Commercial |
$6,043.50
|
| Rate for Payer: First Health Commercial |
$6,399.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,399.00
|
| Rate for Payer: GEHA Commercial |
$5,688.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,399.00
|
| Rate for Payer: Humana ChoiceCare |
$1,848.60
|
| Rate for Payer: Multiplan All |
$6,470.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,266.00
|
| Rate for Payer: OMNI Networks Commercial |
$4,977.00
|
| Rate for Payer: One Health Plan PPO/POS |
$6,399.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,754.50
|
| Rate for Payer: Three Rivers Provider Network All |
$5,332.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,256.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,777.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,612.30
|
| Rate for Payer: Zelis Auto |
$2,844.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,555.00
|
|
|
IMPLT CUP ACETABULAR REGENEREX 60MM
|
Facility
|
IP
|
$7,110.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001838
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,844.00 |
| Max. Negotiated Rate |
$6,754.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,688.00
|
| Rate for Payer: Cash Price |
$4,266.00
|
| Rate for Payer: Cash Price |
$4,266.00
|
| Rate for Payer: Cigna Commercial |
$6,043.50
|
| Rate for Payer: First Health Commercial |
$6,399.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,399.00
|
| Rate for Payer: GEHA Commercial |
$4,977.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,399.00
|
| Rate for Payer: Multiplan All |
$6,470.10
|
| Rate for Payer: OMNI Networks Commercial |
$4,977.00
|
| Rate for Payer: One Health Plan PPO/POS |
$6,399.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,754.50
|
| Rate for Payer: Three Rivers Provider Network All |
$5,332.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,612.30
|
| Rate for Payer: Zelis Auto |
$2,844.00
|
|
|
IMPLT CUP HUMERAL 32X4MM
|
Facility
|
IP
|
$5,371.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002554
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,148.40 |
| Max. Negotiated Rate |
$5,102.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,296.80
|
| Rate for Payer: Cash Price |
$3,222.60
|
| Rate for Payer: Cash Price |
$3,222.60
|
| Rate for Payer: Cigna Commercial |
$4,565.35
|
| Rate for Payer: First Health Commercial |
$4,833.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,833.90
|
| Rate for Payer: GEHA Commercial |
$3,759.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,833.90
|
| Rate for Payer: Multiplan All |
$4,887.61
|
| Rate for Payer: OMNI Networks Commercial |
$3,759.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,833.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,102.45
|
| Rate for Payer: Three Rivers Provider Network All |
$4,028.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,995.03
|
| Rate for Payer: Zelis Auto |
$2,148.40
|
|
|
IMPLT CUP HUMERAL 32X4MM
|
Facility
|
OP
|
$5,371.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002554
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,342.75 |
| Max. Negotiated Rate |
$5,102.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,222.60
|
| Rate for Payer: Cash Price |
$3,222.60
|
| Rate for Payer: Cash Price |
$3,222.60
|
| Rate for Payer: Cigna Commercial |
$4,565.35
|
| Rate for Payer: First Health Commercial |
$4,833.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,833.90
|
| Rate for Payer: GEHA Commercial |
$4,296.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,833.90
|
| Rate for Payer: Humana ChoiceCare |
$1,396.46
|
| Rate for Payer: Multiplan All |
$4,887.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,222.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,759.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,833.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,102.45
|
| Rate for Payer: Three Rivers Provider Network All |
$4,028.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,726.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,342.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,995.03
|
| Rate for Payer: Zelis Auto |
$2,148.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,685.50
|
|
|
IMPLT CUP HUMERAL 36X10MM
|
Facility
|
IP
|
$5,371.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006615
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,148.40 |
| Max. Negotiated Rate |
$5,102.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,296.80
|
| Rate for Payer: Cash Price |
$3,222.60
|
| Rate for Payer: Cash Price |
$3,222.60
|
| Rate for Payer: Cigna Commercial |
$4,565.35
|
| Rate for Payer: First Health Commercial |
$4,833.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,833.90
|
| Rate for Payer: GEHA Commercial |
$3,759.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,833.90
|
| Rate for Payer: Multiplan All |
$4,887.61
|
| Rate for Payer: OMNI Networks Commercial |
$3,759.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,833.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,102.45
|
| Rate for Payer: Three Rivers Provider Network All |
$4,028.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,995.03
|
| Rate for Payer: Zelis Auto |
$2,148.40
|
|
|
IMPLT CUP HUMERAL 36X10MM
|
Facility
|
OP
|
$5,371.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006615
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,342.75 |
| Max. Negotiated Rate |
$5,102.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,222.60
|
| Rate for Payer: Cash Price |
$3,222.60
|
| Rate for Payer: Cash Price |
$3,222.60
|
| Rate for Payer: Cigna Commercial |
$4,565.35
|
| Rate for Payer: First Health Commercial |
$4,833.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,833.90
|
| Rate for Payer: GEHA Commercial |
$4,296.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,833.90
|
| Rate for Payer: Humana ChoiceCare |
$1,396.46
|
| Rate for Payer: Multiplan All |
$4,887.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,222.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,759.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,833.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,102.45
|
| Rate for Payer: Three Rivers Provider Network All |
$4,028.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,726.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,342.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,995.03
|
| Rate for Payer: Zelis Auto |
$2,148.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,685.50
|
|
|
IMPLT CUP HUMERAL 36X4MM
|
Facility
|
IP
|
$5,371.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002599
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,148.40 |
| Max. Negotiated Rate |
$5,102.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,296.80
|
| Rate for Payer: Cash Price |
$3,222.60
|
| Rate for Payer: Cash Price |
$3,222.60
|
| Rate for Payer: Cigna Commercial |
$4,565.35
|
| Rate for Payer: First Health Commercial |
$4,833.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,833.90
|
| Rate for Payer: GEHA Commercial |
$3,759.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,833.90
|
| Rate for Payer: Multiplan All |
$4,887.61
|
| Rate for Payer: OMNI Networks Commercial |
$3,759.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,833.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,102.45
|
| Rate for Payer: Three Rivers Provider Network All |
$4,028.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,995.03
|
| Rate for Payer: Zelis Auto |
$2,148.40
|
|
|
IMPLT CUP HUMERAL 36X4MM
|
Facility
|
OP
|
$5,371.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002599
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,342.75 |
| Max. Negotiated Rate |
$5,102.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,222.60
|
| Rate for Payer: Cash Price |
$3,222.60
|
| Rate for Payer: Cash Price |
$3,222.60
|
| Rate for Payer: Cigna Commercial |
$4,565.35
|
| Rate for Payer: First Health Commercial |
$4,833.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,833.90
|
| Rate for Payer: GEHA Commercial |
$4,296.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,833.90
|
| Rate for Payer: Humana ChoiceCare |
$1,396.46
|
| Rate for Payer: Multiplan All |
$4,887.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,222.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,759.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,833.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,102.45
|
| Rate for Payer: Three Rivers Provider Network All |
$4,028.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,726.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,342.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,995.03
|
| Rate for Payer: Zelis Auto |
$2,148.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,685.50
|
|
|
IMPLT CUP HUMERAL REUNION 40X10MM
|
Facility
|
OP
|
$9,242.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002612
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,310.50 |
| Max. Negotiated Rate |
$8,779.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,545.20
|
| Rate for Payer: Cash Price |
$5,545.20
|
| Rate for Payer: Cash Price |
$5,545.20
|
| Rate for Payer: Cigna Commercial |
$7,855.70
|
| Rate for Payer: First Health Commercial |
$8,317.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,317.80
|
| Rate for Payer: GEHA Commercial |
$7,393.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,317.80
|
| Rate for Payer: Humana ChoiceCare |
$2,402.92
|
| Rate for Payer: Multiplan All |
$8,410.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,545.20
|
| Rate for Payer: OMNI Networks Commercial |
$6,469.40
|
| Rate for Payer: One Health Plan PPO/POS |
$8,317.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,779.90
|
| Rate for Payer: Three Rivers Provider Network All |
$6,931.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8,132.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,310.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,595.06
|
| Rate for Payer: Zelis Auto |
$3,696.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,621.00
|
|
|
IMPLT CUP HUMERAL REUNION 40X10MM
|
Facility
|
IP
|
$9,242.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002612
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,696.80 |
| Max. Negotiated Rate |
$8,779.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7,393.60
|
| Rate for Payer: Cash Price |
$5,545.20
|
| Rate for Payer: Cash Price |
$5,545.20
|
| Rate for Payer: Cigna Commercial |
$7,855.70
|
| Rate for Payer: First Health Commercial |
$8,317.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,317.80
|
| Rate for Payer: GEHA Commercial |
$6,469.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,317.80
|
| Rate for Payer: Multiplan All |
$8,410.22
|
| Rate for Payer: OMNI Networks Commercial |
$6,469.40
|
| Rate for Payer: One Health Plan PPO/POS |
$8,317.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,779.90
|
| Rate for Payer: Three Rivers Provider Network All |
$6,931.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,595.06
|
| Rate for Payer: Zelis Auto |
$3,696.80
|
|
|
IMPLT CUP HUMERAL REUNION 40X4MM
|
Facility
|
OP
|
$5,371.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002708
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,342.75 |
| Max. Negotiated Rate |
$5,102.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,222.60
|
| Rate for Payer: Cash Price |
$3,222.60
|
| Rate for Payer: Cash Price |
$3,222.60
|
| Rate for Payer: Cigna Commercial |
$4,565.35
|
| Rate for Payer: First Health Commercial |
$4,833.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,833.90
|
| Rate for Payer: GEHA Commercial |
$4,296.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,833.90
|
| Rate for Payer: Humana ChoiceCare |
$1,396.46
|
| Rate for Payer: Multiplan All |
$4,887.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,222.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,759.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,833.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,102.45
|
| Rate for Payer: Three Rivers Provider Network All |
$4,028.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,726.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,342.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,995.03
|
| Rate for Payer: Zelis Auto |
$2,148.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,685.50
|
|
|
IMPLT CUP HUMERAL REUNION 40X4MM
|
Facility
|
IP
|
$5,371.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002708
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,148.40 |
| Max. Negotiated Rate |
$5,102.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,296.80
|
| Rate for Payer: Cash Price |
$3,222.60
|
| Rate for Payer: Cash Price |
$3,222.60
|
| Rate for Payer: Cigna Commercial |
$4,565.35
|
| Rate for Payer: First Health Commercial |
$4,833.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,833.90
|
| Rate for Payer: GEHA Commercial |
$3,759.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,833.90
|
| Rate for Payer: Multiplan All |
$4,887.61
|
| Rate for Payer: OMNI Networks Commercial |
$3,759.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,833.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,102.45
|
| Rate for Payer: Three Rivers Provider Network All |
$4,028.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,995.03
|
| Rate for Payer: Zelis Auto |
$2,148.40
|
|
|
IMPLT CURCIATE FEMORAL SZ4 RIGHT
|
Facility
|
IP
|
$7,225.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006524
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,890.00 |
| Max. Negotiated Rate |
$6,863.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,780.00
|
| Rate for Payer: Cash Price |
$4,335.00
|
| Rate for Payer: Cash Price |
$4,335.00
|
| Rate for Payer: Cigna Commercial |
$6,141.25
|
| Rate for Payer: First Health Commercial |
$6,502.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,502.50
|
| Rate for Payer: GEHA Commercial |
$5,057.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,502.50
|
| Rate for Payer: Multiplan All |
$6,574.75
|
| Rate for Payer: OMNI Networks Commercial |
$5,057.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,502.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,863.75
|
| Rate for Payer: Three Rivers Provider Network All |
$5,418.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,719.25
|
| Rate for Payer: Zelis Auto |
$2,890.00
|
|
