|
IMPLT FEMORAL RETAINING CRUCIATE SIZE 8
|
Facility
|
IP
|
$8,298.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001979
|
|
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 SIZE 4 LEFT
|
Facility
|
IP
|
$5,807.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001980
|
|
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 SIZE 4 LEFT
|
Facility
|
OP
|
$5,807.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001980
|
|
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 STABILIZED POSTERIOR # 2
|
Facility
|
OP
|
$6,105.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001982
|
|
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 STABILIZED POSTERIOR # 2
|
Facility
|
IP
|
$6,105.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001982
|
|
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 STABILIZED POSTERIOR #4
|
Facility
|
IP
|
$6,775.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006413
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,710.00 |
| Max. Negotiated Rate |
$6,436.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,420.00
|
| Rate for Payer: Cash Price |
$4,065.00
|
| Rate for Payer: Cash Price |
$4,065.00
|
| Rate for Payer: Cigna Commercial |
$5,758.75
|
| Rate for Payer: First Health Commercial |
$6,097.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,097.50
|
| Rate for Payer: GEHA Commercial |
$4,742.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,097.50
|
| Rate for Payer: Multiplan All |
$6,165.25
|
| Rate for Payer: OMNI Networks Commercial |
$4,742.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,097.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,436.25
|
| Rate for Payer: Three Rivers Provider Network All |
$5,081.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,300.75
|
| Rate for Payer: Zelis Auto |
$2,710.00
|
|
|
IMPLT FEMORAL STABILIZED POSTERIOR #4
|
Facility
|
OP
|
$6,775.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006413
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,693.75 |
| Max. Negotiated Rate |
$6,436.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,065.00
|
| Rate for Payer: Cash Price |
$4,065.00
|
| Rate for Payer: Cash Price |
$4,065.00
|
| Rate for Payer: Cigna Commercial |
$5,758.75
|
| Rate for Payer: First Health Commercial |
$6,097.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,097.50
|
| Rate for Payer: GEHA Commercial |
$5,420.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,097.50
|
| Rate for Payer: Humana ChoiceCare |
$1,761.50
|
| Rate for Payer: Multiplan All |
$6,165.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,065.00
|
| Rate for Payer: OMNI Networks Commercial |
$4,742.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,097.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,436.25
|
| Rate for Payer: Three Rivers Provider Network All |
$5,081.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,962.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,693.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,300.75
|
| Rate for Payer: Zelis Auto |
$2,710.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,387.50
|
|
|
IMPLT FEMORAL STABILIZED POSTERIOR #7
|
Facility
|
OP
|
$6,105.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001983
|
|
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 STABILIZED POSTERIOR #7
|
Facility
|
IP
|
$6,105.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001983
|
|
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 STABILIZED POSTERIOR SIZE3
|
Facility
|
IP
|
$5,807.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001984
|
|
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 STABILIZED POSTERIOR SIZE3
|
Facility
|
OP
|
$5,807.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001984
|
|
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 STABILIZED POSTERIOR SZ6
|
Facility
|
OP
|
$8,298.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001989
|
|
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 STABILIZED POSTERIOR SZ6
|
Facility
|
IP
|
$8,298.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001989
|
|
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 STABILIZED POST SZE 3 LEFT
|
Facility
|
OP
|
$5,807.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001981
|
|
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 STABILIZED POST SZE 3 LEFT
|
Facility
|
IP
|
$5,807.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001981
|
|
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 STANDARD STEM
|
Facility
|
IP
|
$11,890.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003083
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,756.00 |
| Max. Negotiated Rate |
$11,295.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9,512.00
|
| Rate for Payer: Cash Price |
$7,134.00
|
| Rate for Payer: Cash Price |
$7,134.00
|
| Rate for Payer: Cigna Commercial |
$10,106.50
|
| Rate for Payer: First Health Commercial |
$10,701.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10,701.00
|
| Rate for Payer: GEHA Commercial |
$8,323.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10,701.00
|
| Rate for Payer: Multiplan All |
$10,819.90
|
| Rate for Payer: OMNI Networks Commercial |
$8,323.00
|
| Rate for Payer: One Health Plan PPO/POS |
$10,701.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$11,295.50
|
| Rate for Payer: Three Rivers Provider Network All |
$8,917.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$11,057.70
|
| Rate for Payer: Zelis Auto |
$4,756.00
|
|
|
IMPLT FEMORAL STANDARD STEM
|
Facility
|
OP
|
$11,890.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003083
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,972.50 |
| Max. Negotiated Rate |
$11,295.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7,134.00
|
| Rate for Payer: Cash Price |
$7,134.00
|
| Rate for Payer: Cash Price |
$7,134.00
|
| Rate for Payer: Cigna Commercial |
$10,106.50
|
| Rate for Payer: First Health Commercial |
$10,701.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10,701.00
|
| Rate for Payer: GEHA Commercial |
$9,512.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10,701.00
|
| Rate for Payer: Humana ChoiceCare |
$3,091.40
|
| Rate for Payer: Multiplan All |
$10,819.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7,134.00
|
| Rate for Payer: OMNI Networks Commercial |
$8,323.00
|
| Rate for Payer: One Health Plan PPO/POS |
$10,701.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$11,295.50
|
| Rate for Payer: Three Rivers Provider Network All |
$8,917.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10,463.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,972.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$11,057.70
|
| Rate for Payer: Zelis Auto |
$4,756.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,945.00
|
|
|
IMPLT FIBERSTITCH CURVED
|
Facility
|
OP
|
$2,230.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009238
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$557.50 |
| Max. Negotiated Rate |
$2,118.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,338.00
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$1,895.50
|
| Rate for Payer: First Health Commercial |
$2,007.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,007.00
|
| Rate for Payer: GEHA Commercial |
$1,784.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,007.00
|
| Rate for Payer: Humana ChoiceCare |
$579.80
|
| Rate for Payer: Multiplan All |
$2,029.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,338.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,561.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,007.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,118.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,672.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,962.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$557.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,073.90
|
| Rate for Payer: Zelis Auto |
$892.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,115.00
|
|
|
IMPLT FIBERSTITCH CURVED
|
Facility
|
IP
|
$2,230.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009238
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$892.00 |
| Max. Negotiated Rate |
$2,118.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,784.00
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$1,895.50
|
| Rate for Payer: First Health Commercial |
$2,007.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,007.00
|
| Rate for Payer: GEHA Commercial |
$1,561.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,007.00
|
| Rate for Payer: Multiplan All |
$2,029.30
|
| Rate for Payer: OMNI Networks Commercial |
$1,561.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,007.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,118.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,672.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,073.90
|
| Rate for Payer: Zelis Auto |
$892.00
|
|
|
IMPLT FIBERSTITCH CURVED 24 DEGREE
|
Facility
|
IP
|
$2,230.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009234
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$892.00 |
| Max. Negotiated Rate |
$2,118.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,784.00
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$1,895.50
|
| Rate for Payer: First Health Commercial |
$2,007.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,007.00
|
| Rate for Payer: GEHA Commercial |
$1,561.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,007.00
|
| Rate for Payer: Multiplan All |
$2,029.30
|
| Rate for Payer: OMNI Networks Commercial |
$1,561.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,007.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,118.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,672.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,073.90
|
| Rate for Payer: Zelis Auto |
$892.00
|
|
|
IMPLT FIBERSTITCH CURVED 24 DEGREE
|
Facility
|
OP
|
$2,230.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009234
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$557.50 |
| Max. Negotiated Rate |
$2,118.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,338.00
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$1,895.50
|
| Rate for Payer: First Health Commercial |
$2,007.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,007.00
|
| Rate for Payer: GEHA Commercial |
$1,784.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,007.00
|
| Rate for Payer: Humana ChoiceCare |
$579.80
|
| Rate for Payer: Multiplan All |
$2,029.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,338.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,561.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,007.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,118.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,672.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,962.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$557.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,073.90
|
| Rate for Payer: Zelis Auto |
$892.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,115.00
|
|
|
IMPLT FIBERTAK DOUBLELOAD 1.8MM
|
Facility
|
OP
|
$1,756.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003447
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$439.00 |
| Max. Negotiated Rate |
$1,668.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,053.60
|
| Rate for Payer: Cash Price |
$1,053.60
|
| Rate for Payer: Cash Price |
$1,053.60
|
| Rate for Payer: Cigna Commercial |
$1,492.60
|
| Rate for Payer: First Health Commercial |
$1,580.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,580.40
|
| Rate for Payer: GEHA Commercial |
$1,404.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,580.40
|
| Rate for Payer: Humana ChoiceCare |
$456.56
|
| Rate for Payer: Multiplan All |
$1,597.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,053.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,229.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,580.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,668.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,317.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,545.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$439.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,633.08
|
| Rate for Payer: Zelis Auto |
$702.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$878.00
|
|
|
IMPLT FIBERTAK DOUBLELOAD 1.8MM
|
Facility
|
IP
|
$1,756.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003447
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$702.40 |
| Max. Negotiated Rate |
$1,668.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,404.80
|
| Rate for Payer: Cash Price |
$1,053.60
|
| Rate for Payer: Cash Price |
$1,053.60
|
| Rate for Payer: Cigna Commercial |
$1,492.60
|
| Rate for Payer: First Health Commercial |
$1,580.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,580.40
|
| Rate for Payer: GEHA Commercial |
$1,229.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,580.40
|
| Rate for Payer: Multiplan All |
$1,597.96
|
| Rate for Payer: OMNI Networks Commercial |
$1,229.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,580.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,668.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,317.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,633.08
|
| Rate for Payer: Zelis Auto |
$702.40
|
|
|
IMPLT FIBERTAK DOUBLE LOADED KNOTLESS
|
Facility
|
OP
|
$1,756.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003484
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$439.00 |
| Max. Negotiated Rate |
$1,668.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,053.60
|
| Rate for Payer: Cash Price |
$1,053.60
|
| Rate for Payer: Cash Price |
$1,053.60
|
| Rate for Payer: Cigna Commercial |
$1,492.60
|
| Rate for Payer: First Health Commercial |
$1,580.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,580.40
|
| Rate for Payer: GEHA Commercial |
$1,404.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,580.40
|
| Rate for Payer: Humana ChoiceCare |
$456.56
|
| Rate for Payer: Multiplan All |
$1,597.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,053.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,229.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,580.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,668.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,317.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,545.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$439.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,633.08
|
| Rate for Payer: Zelis Auto |
$702.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$878.00
|
|
|
IMPLT FIBERTAK DOUBLE LOADED KNOTLESS
|
Facility
|
IP
|
$1,756.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003484
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$702.40 |
| Max. Negotiated Rate |
$1,668.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,404.80
|
| Rate for Payer: Cash Price |
$1,053.60
|
| Rate for Payer: Cash Price |
$1,053.60
|
| Rate for Payer: Cigna Commercial |
$1,492.60
|
| Rate for Payer: First Health Commercial |
$1,580.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,580.40
|
| Rate for Payer: GEHA Commercial |
$1,229.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,580.40
|
| Rate for Payer: Multiplan All |
$1,597.96
|
| Rate for Payer: OMNI Networks Commercial |
$1,229.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,580.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,668.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,317.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,633.08
|
| Rate for Payer: Zelis Auto |
$702.40
|
|
