|
IMPLT FEMORAL POSTERIOR #5 LEFT
|
Facility
|
OP
|
$5,633.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001978
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,408.25 |
| Max. Negotiated Rate |
$5,351.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,379.80
|
| Rate for Payer: Cash Price |
$3,379.80
|
| Rate for Payer: Cash Price |
$3,379.80
|
| Rate for Payer: Cigna Commercial |
$4,788.05
|
| Rate for Payer: First Health Commercial |
$5,069.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,069.70
|
| Rate for Payer: GEHA Commercial |
$4,506.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,069.70
|
| Rate for Payer: Humana ChoiceCare |
$1,464.58
|
| Rate for Payer: Multiplan All |
$5,126.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,379.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,943.10
|
| Rate for Payer: One Health Plan PPO/POS |
$5,069.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,351.35
|
| Rate for Payer: Three Rivers Provider Network All |
$4,224.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,957.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,408.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,238.69
|
| Rate for Payer: Zelis Auto |
$2,253.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,816.50
|
|
|
IMPLT FEMORAL POSTERIOR #5 LEFT
|
Facility
|
IP
|
$5,633.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001978
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,253.20 |
| Max. Negotiated Rate |
$5,351.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,506.40
|
| Rate for Payer: Cash Price |
$3,379.80
|
| Rate for Payer: Cash Price |
$3,379.80
|
| Rate for Payer: Cigna Commercial |
$4,788.05
|
| Rate for Payer: First Health Commercial |
$5,069.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,069.70
|
| Rate for Payer: GEHA Commercial |
$3,943.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,069.70
|
| Rate for Payer: Multiplan All |
$5,126.03
|
| Rate for Payer: OMNI Networks Commercial |
$3,943.10
|
| Rate for Payer: One Health Plan PPO/POS |
$5,069.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,351.35
|
| Rate for Payer: Three Rivers Provider Network All |
$4,224.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,238.69
|
| Rate for Payer: Zelis Auto |
$2,253.20
|
|
|
IMPLT FEMORAL POSTERIOR #7 RIGHT
|
Facility
|
IP
|
$6,105.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001988
|
|
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 FEMORAL POSTERIOR #7 RIGHT
|
Facility
|
OP
|
$6,105.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001988
|
|
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 FEMORAL POSTERIOR SIZE 8
|
Facility
|
IP
|
$6,105.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001985
|
|
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 FEMORAL POSTERIOR SIZE 8
|
Facility
|
OP
|
$6,105.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001985
|
|
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 FEMORAL POSTERIOR SIZE 8 LEFT
|
Facility
|
OP
|
$6,105.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001986
|
|
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 FEMORAL POSTERIOR SIZE 8 LEFT
|
Facility
|
IP
|
$6,105.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001986
|
|
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 FEMORAL POSTERIOR STABILIZED #5
|
Facility
|
IP
|
$8,298.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001974
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,319.20 |
| Max. Negotiated Rate |
$7,883.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,638.40
|
| Rate for Payer: Cash Price |
$4,978.80
|
| Rate for Payer: Cash Price |
$4,978.80
|
| Rate for Payer: Cigna Commercial |
$7,053.30
|
| Rate for Payer: First Health Commercial |
$7,468.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,468.20
|
| Rate for Payer: GEHA Commercial |
$5,808.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,468.20
|
| Rate for Payer: Multiplan All |
$7,551.18
|
| Rate for Payer: OMNI Networks Commercial |
$5,808.60
|
| Rate for Payer: One Health Plan PPO/POS |
$7,468.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,883.10
|
| Rate for Payer: Three Rivers Provider Network All |
$6,223.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,717.14
|
| Rate for Payer: Zelis Auto |
$3,319.20
|
|
|
IMPLT FEMORAL POSTERIOR STABILIZED #5
|
Facility
|
OP
|
$8,298.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001974
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,074.50 |
| Max. Negotiated Rate |
$7,883.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,978.80
|
| Rate for Payer: Cash Price |
$4,978.80
|
| Rate for Payer: Cash Price |
$4,978.80
|
| Rate for Payer: Cigna Commercial |
$7,053.30
|
| Rate for Payer: First Health Commercial |
$7,468.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,468.20
|
| Rate for Payer: GEHA Commercial |
$6,638.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,468.20
|
| Rate for Payer: Humana ChoiceCare |
$2,157.48
|
| Rate for Payer: Multiplan All |
$7,551.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,978.80
|
| Rate for Payer: OMNI Networks Commercial |
$5,808.60
|
| Rate for Payer: One Health Plan PPO/POS |
$7,468.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,883.10
|
| Rate for Payer: Three Rivers Provider Network All |
$6,223.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,302.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,074.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,717.14
|
| Rate for Payer: Zelis Auto |
$3,319.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,149.00
|
|
|
IMPLT FEMORAL POSTERIOR STABILIZED #7
|
Facility
|
IP
|
$8,298.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001975
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,319.20 |
| Max. Negotiated Rate |
$7,883.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,638.40
|
| Rate for Payer: Cash Price |
$4,978.80
|
| Rate for Payer: Cash Price |
$4,978.80
|
| Rate for Payer: Cigna Commercial |
$7,053.30
|
| Rate for Payer: First Health Commercial |
$7,468.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,468.20
|
| Rate for Payer: GEHA Commercial |
$5,808.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,468.20
|
| Rate for Payer: Multiplan All |
$7,551.18
|
| Rate for Payer: OMNI Networks Commercial |
$5,808.60
|
| Rate for Payer: One Health Plan PPO/POS |
$7,468.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,883.10
|
| Rate for Payer: Three Rivers Provider Network All |
$6,223.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,717.14
|
| Rate for Payer: Zelis Auto |
$3,319.20
|
|
|
IMPLT FEMORAL POSTERIOR STABILIZED #7
|
Facility
|
OP
|
$8,298.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001975
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,074.50 |
| Max. Negotiated Rate |
$7,883.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,978.80
|
| Rate for Payer: Cash Price |
$4,978.80
|
| Rate for Payer: Cash Price |
$4,978.80
|
| Rate for Payer: Cigna Commercial |
$7,053.30
|
| Rate for Payer: First Health Commercial |
$7,468.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,468.20
|
| Rate for Payer: GEHA Commercial |
$6,638.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,468.20
|
| Rate for Payer: Humana ChoiceCare |
$2,157.48
|
| Rate for Payer: Multiplan All |
$7,551.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,978.80
|
| Rate for Payer: OMNI Networks Commercial |
$5,808.60
|
| Rate for Payer: One Health Plan PPO/POS |
$7,468.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,883.10
|
| Rate for Payer: Three Rivers Provider Network All |
$6,223.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,302.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,074.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,717.14
|
| Rate for Payer: Zelis Auto |
$3,319.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,149.00
|
|
|
IMPLT FEMORAL POSTERIOR STABILIZED #8
|
Facility
|
IP
|
$8,298.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001976
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,319.20 |
| Max. Negotiated Rate |
$7,883.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,638.40
|
| Rate for Payer: Cash Price |
$4,978.80
|
| Rate for Payer: Cash Price |
$4,978.80
|
| Rate for Payer: Cigna Commercial |
$7,053.30
|
| Rate for Payer: First Health Commercial |
$7,468.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,468.20
|
| Rate for Payer: GEHA Commercial |
$5,808.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,468.20
|
| Rate for Payer: Multiplan All |
$7,551.18
|
| Rate for Payer: OMNI Networks Commercial |
$5,808.60
|
| Rate for Payer: One Health Plan PPO/POS |
$7,468.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,883.10
|
| Rate for Payer: Three Rivers Provider Network All |
$6,223.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,717.14
|
| Rate for Payer: Zelis Auto |
$3,319.20
|
|
|
IMPLT FEMORAL POSTERIOR STABILIZED #8
|
Facility
|
OP
|
$8,298.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001976
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,074.50 |
| Max. Negotiated Rate |
$7,883.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,978.80
|
| Rate for Payer: Cash Price |
$4,978.80
|
| Rate for Payer: Cash Price |
$4,978.80
|
| Rate for Payer: Cigna Commercial |
$7,053.30
|
| Rate for Payer: First Health Commercial |
$7,468.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,468.20
|
| Rate for Payer: GEHA Commercial |
$6,638.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,468.20
|
| Rate for Payer: Humana ChoiceCare |
$2,157.48
|
| Rate for Payer: Multiplan All |
$7,551.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,978.80
|
| Rate for Payer: OMNI Networks Commercial |
$5,808.60
|
| Rate for Payer: One Health Plan PPO/POS |
$7,468.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,883.10
|
| Rate for Payer: Three Rivers Provider Network All |
$6,223.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,302.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,074.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,717.14
|
| Rate for Payer: Zelis Auto |
$3,319.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,149.00
|
|
|
IMPLT FEMORAL POSTERIOR STABILIZED SIZE2
|
Facility
|
OP
|
$7,225.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003424
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,806.25 |
| Max. Negotiated Rate |
$6,863.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,335.00
|
| 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 |
$5,780.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,502.50
|
| Rate for Payer: Humana ChoiceCare |
$1,878.50
|
| Rate for Payer: Multiplan All |
$6,574.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,335.00
|
| 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: TriWest Veterans Administration/VAPC3 |
$6,358.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,806.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,719.25
|
| Rate for Payer: Zelis Auto |
$2,890.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,612.50
|
|
|
IMPLT FEMORAL POSTERIOR STABILIZED SIZE2
|
Facility
|
IP
|
$7,225.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003424
|
|
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
|
|
|
IMPLT FEMORAL POSTERIOR STABILIZED SIZE3
|
Facility
|
IP
|
$8,298.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006154
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,319.20 |
| Max. Negotiated Rate |
$7,883.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,638.40
|
| Rate for Payer: Cash Price |
$4,978.80
|
| Rate for Payer: Cash Price |
$4,978.80
|
| Rate for Payer: Cigna Commercial |
$7,053.30
|
| Rate for Payer: First Health Commercial |
$7,468.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,468.20
|
| Rate for Payer: GEHA Commercial |
$5,808.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,468.20
|
| Rate for Payer: Multiplan All |
$7,551.18
|
| Rate for Payer: OMNI Networks Commercial |
$5,808.60
|
| Rate for Payer: One Health Plan PPO/POS |
$7,468.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,883.10
|
| Rate for Payer: Three Rivers Provider Network All |
$6,223.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,717.14
|
| Rate for Payer: Zelis Auto |
$3,319.20
|
|
|
IMPLT FEMORAL POSTERIOR STABILIZED SIZE3
|
Facility
|
OP
|
$8,298.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006154
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,074.50 |
| Max. Negotiated Rate |
$7,883.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,978.80
|
| Rate for Payer: Cash Price |
$4,978.80
|
| Rate for Payer: Cash Price |
$4,978.80
|
| Rate for Payer: Cigna Commercial |
$7,053.30
|
| Rate for Payer: First Health Commercial |
$7,468.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,468.20
|
| Rate for Payer: GEHA Commercial |
$6,638.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,468.20
|
| Rate for Payer: Humana ChoiceCare |
$2,157.48
|
| Rate for Payer: Multiplan All |
$7,551.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,978.80
|
| Rate for Payer: OMNI Networks Commercial |
$5,808.60
|
| Rate for Payer: One Health Plan PPO/POS |
$7,468.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,883.10
|
| Rate for Payer: Three Rivers Provider Network All |
$6,223.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,302.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,074.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,717.14
|
| Rate for Payer: Zelis Auto |
$3,319.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,149.00
|
|
|
IMPLT FEMORAL POSTERIOR STABIL SIZE #7
|
Facility
|
OP
|
$7,225.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001987
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,806.25 |
| Max. Negotiated Rate |
$6,863.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,335.00
|
| 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 |
$5,780.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,502.50
|
| Rate for Payer: Humana ChoiceCare |
$1,878.50
|
| Rate for Payer: Multiplan All |
$6,574.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,335.00
|
| 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: TriWest Veterans Administration/VAPC3 |
$6,358.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,806.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,719.25
|
| Rate for Payer: Zelis Auto |
$2,890.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,612.50
|
|
|
IMPLT FEMORAL POSTERIOR STABIL SIZE #7
|
Facility
|
IP
|
$7,225.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001987
|
|
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
|
|
|
IMPLT FEMORAL POSTERIOR SZ.5 RIGHT
|
Facility
|
IP
|
$5,807.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001977
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,322.80 |
| Max. Negotiated Rate |
$5,516.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,645.60
|
| Rate for Payer: Cash Price |
$3,484.20
|
| Rate for Payer: Cash Price |
$3,484.20
|
| Rate for Payer: Cigna Commercial |
$4,935.95
|
| Rate for Payer: First Health Commercial |
$5,226.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,226.30
|
| Rate for Payer: GEHA Commercial |
$4,064.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,226.30
|
| Rate for Payer: Multiplan All |
$5,284.37
|
| Rate for Payer: OMNI Networks Commercial |
$4,064.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,226.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,516.65
|
| Rate for Payer: Three Rivers Provider Network All |
$4,355.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,400.51
|
| Rate for Payer: Zelis Auto |
$2,322.80
|
|
|
IMPLT FEMORAL POSTERIOR SZ.5 RIGHT
|
Facility
|
OP
|
$5,807.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001977
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,451.75 |
| Max. Negotiated Rate |
$5,516.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,484.20
|
| Rate for Payer: Cash Price |
$3,484.20
|
| Rate for Payer: Cash Price |
$3,484.20
|
| Rate for Payer: Cigna Commercial |
$4,935.95
|
| Rate for Payer: First Health Commercial |
$5,226.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,226.30
|
| Rate for Payer: GEHA Commercial |
$4,645.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,226.30
|
| Rate for Payer: Humana ChoiceCare |
$1,509.82
|
| Rate for Payer: Multiplan All |
$5,284.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,484.20
|
| Rate for Payer: OMNI Networks Commercial |
$4,064.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,226.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,516.65
|
| Rate for Payer: Three Rivers Provider Network All |
$4,355.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,110.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,451.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,400.51
|
| Rate for Payer: Zelis Auto |
$2,322.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,903.50
|
|
|
IMPLT FEMORAL RETAINING CRUCIATE 8 SIZE
|
Facility
|
OP
|
$5,807.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006123
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,451.75 |
| Max. Negotiated Rate |
$5,516.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,484.20
|
| Rate for Payer: Cash Price |
$3,484.20
|
| Rate for Payer: Cash Price |
$3,484.20
|
| Rate for Payer: Cigna Commercial |
$4,935.95
|
| Rate for Payer: First Health Commercial |
$5,226.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,226.30
|
| Rate for Payer: GEHA Commercial |
$4,645.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,226.30
|
| Rate for Payer: Humana ChoiceCare |
$1,509.82
|
| Rate for Payer: Multiplan All |
$5,284.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,484.20
|
| Rate for Payer: OMNI Networks Commercial |
$4,064.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,226.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,516.65
|
| Rate for Payer: Three Rivers Provider Network All |
$4,355.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,110.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,451.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,400.51
|
| Rate for Payer: Zelis Auto |
$2,322.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,903.50
|
|
|
IMPLT FEMORAL RETAINING CRUCIATE 8 SIZE
|
Facility
|
IP
|
$5,807.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006123
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,322.80 |
| Max. Negotiated Rate |
$5,516.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,645.60
|
| Rate for Payer: Cash Price |
$3,484.20
|
| Rate for Payer: Cash Price |
$3,484.20
|
| Rate for Payer: Cigna Commercial |
$4,935.95
|
| Rate for Payer: First Health Commercial |
$5,226.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,226.30
|
| Rate for Payer: GEHA Commercial |
$4,064.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,226.30
|
| Rate for Payer: Multiplan All |
$5,284.37
|
| Rate for Payer: OMNI Networks Commercial |
$4,064.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,226.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,516.65
|
| Rate for Payer: Three Rivers Provider Network All |
$4,355.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,400.51
|
| Rate for Payer: Zelis Auto |
$2,322.80
|
|
|
IMPLT FEMORAL RETAINING CRUCIATE SIZE 8
|
Facility
|
OP
|
$8,298.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001979
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,074.50 |
| Max. Negotiated Rate |
$7,883.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,978.80
|
| Rate for Payer: Cash Price |
$4,978.80
|
| Rate for Payer: Cash Price |
$4,978.80
|
| Rate for Payer: Cigna Commercial |
$7,053.30
|
| Rate for Payer: First Health Commercial |
$7,468.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,468.20
|
| Rate for Payer: GEHA Commercial |
$6,638.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,468.20
|
| Rate for Payer: Humana ChoiceCare |
$2,157.48
|
| Rate for Payer: Multiplan All |
$7,551.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,978.80
|
| Rate for Payer: OMNI Networks Commercial |
$5,808.60
|
| Rate for Payer: One Health Plan PPO/POS |
$7,468.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,883.10
|
| Rate for Payer: Three Rivers Provider Network All |
$6,223.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,302.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,074.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,717.14
|
| Rate for Payer: Zelis Auto |
$3,319.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,149.00
|
|
