|
IMPLT GLENOSPHERE CONCENTRIC 36X6MM
|
Facility
|
OP
|
$6,899.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002597
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,724.75 |
| Max. Negotiated Rate |
$6,554.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,139.40
|
| Rate for Payer: Cash Price |
$4,139.40
|
| Rate for Payer: Cash Price |
$4,139.40
|
| Rate for Payer: Cigna Commercial |
$5,864.15
|
| Rate for Payer: First Health Commercial |
$6,209.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,209.10
|
| Rate for Payer: GEHA Commercial |
$5,519.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,209.10
|
| Rate for Payer: Humana ChoiceCare |
$1,793.74
|
| Rate for Payer: Multiplan All |
$6,278.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,139.40
|
| Rate for Payer: OMNI Networks Commercial |
$4,829.30
|
| Rate for Payer: One Health Plan PPO/POS |
$6,209.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,554.05
|
| Rate for Payer: Three Rivers Provider Network All |
$5,174.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,071.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,724.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,416.07
|
| Rate for Payer: Zelis Auto |
$2,759.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,449.50
|
|
|
IMPLT GLENOSPHERE CONCENTRIC 36X6MM
|
Facility
|
IP
|
$6,899.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002597
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,759.60 |
| Max. Negotiated Rate |
$6,554.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,519.20
|
| Rate for Payer: Cash Price |
$4,139.40
|
| Rate for Payer: Cash Price |
$4,139.40
|
| Rate for Payer: Cigna Commercial |
$5,864.15
|
| Rate for Payer: First Health Commercial |
$6,209.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,209.10
|
| Rate for Payer: GEHA Commercial |
$4,829.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,209.10
|
| Rate for Payer: Multiplan All |
$6,278.09
|
| Rate for Payer: OMNI Networks Commercial |
$4,829.30
|
| Rate for Payer: One Health Plan PPO/POS |
$6,209.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,554.05
|
| Rate for Payer: Three Rivers Provider Network All |
$5,174.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,416.07
|
| Rate for Payer: Zelis Auto |
$2,759.60
|
|
|
IMPLT GLENOSPHERE CONCENTRIC 40MM
|
Facility
|
IP
|
$6,899.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002707
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,759.60 |
| Max. Negotiated Rate |
$6,554.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,519.20
|
| Rate for Payer: Cash Price |
$4,139.40
|
| Rate for Payer: Cash Price |
$4,139.40
|
| Rate for Payer: Cigna Commercial |
$5,864.15
|
| Rate for Payer: First Health Commercial |
$6,209.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,209.10
|
| Rate for Payer: GEHA Commercial |
$4,829.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,209.10
|
| Rate for Payer: Multiplan All |
$6,278.09
|
| Rate for Payer: OMNI Networks Commercial |
$4,829.30
|
| Rate for Payer: One Health Plan PPO/POS |
$6,209.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,554.05
|
| Rate for Payer: Three Rivers Provider Network All |
$5,174.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,416.07
|
| Rate for Payer: Zelis Auto |
$2,759.60
|
|
|
IMPLT GLENOSPHERE CONCENTRIC 40MM
|
Facility
|
OP
|
$6,899.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002707
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,724.75 |
| Max. Negotiated Rate |
$6,554.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,139.40
|
| Rate for Payer: Cash Price |
$4,139.40
|
| Rate for Payer: Cash Price |
$4,139.40
|
| Rate for Payer: Cigna Commercial |
$5,864.15
|
| Rate for Payer: First Health Commercial |
$6,209.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,209.10
|
| Rate for Payer: GEHA Commercial |
$5,519.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,209.10
|
| Rate for Payer: Humana ChoiceCare |
$1,793.74
|
| Rate for Payer: Multiplan All |
$6,278.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,139.40
|
| Rate for Payer: OMNI Networks Commercial |
$4,829.30
|
| Rate for Payer: One Health Plan PPO/POS |
$6,209.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,554.05
|
| Rate for Payer: Three Rivers Provider Network All |
$5,174.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,071.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,724.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,416.07
|
| Rate for Payer: Zelis Auto |
$2,759.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,449.50
|
|
|
IMPLT GLENOSPHERE ECCENTRIC 2MM
|
Facility
|
OP
|
$6,899.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
70090028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,724.75 |
| Max. Negotiated Rate |
$6,554.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,139.40
|
| Rate for Payer: Cash Price |
$4,139.40
|
| Rate for Payer: Cash Price |
$4,139.40
|
| Rate for Payer: Cigna Commercial |
$5,864.15
|
| Rate for Payer: First Health Commercial |
$6,209.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,209.10
|
| Rate for Payer: GEHA Commercial |
$5,519.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,209.10
|
| Rate for Payer: Humana ChoiceCare |
$1,793.74
|
| Rate for Payer: Multiplan All |
$6,278.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,139.40
|
| Rate for Payer: OMNI Networks Commercial |
$4,829.30
|
| Rate for Payer: One Health Plan PPO/POS |
$6,209.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,554.05
|
| Rate for Payer: Three Rivers Provider Network All |
$5,174.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,071.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,724.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,416.07
|
| Rate for Payer: Zelis Auto |
$2,759.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,449.50
|
|
|
IMPLT GLENOSPHERE ECCENTRIC 2MM
|
Facility
|
IP
|
$6,899.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
70090028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,759.60 |
| Max. Negotiated Rate |
$6,554.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,519.20
|
| Rate for Payer: Cash Price |
$4,139.40
|
| Rate for Payer: Cash Price |
$4,139.40
|
| Rate for Payer: Cigna Commercial |
$5,864.15
|
| Rate for Payer: First Health Commercial |
$6,209.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,209.10
|
| Rate for Payer: GEHA Commercial |
$4,829.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,209.10
|
| Rate for Payer: Multiplan All |
$6,278.09
|
| Rate for Payer: OMNI Networks Commercial |
$4,829.30
|
| Rate for Payer: One Health Plan PPO/POS |
$6,209.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,554.05
|
| Rate for Payer: Three Rivers Provider Network All |
$5,174.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,416.07
|
| Rate for Payer: Zelis Auto |
$2,759.60
|
|
|
IMPLT GLENOSPHERE ECCENTRIC 2MM 36MM 2MM
|
Facility
|
IP
|
$6,899.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003325
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,759.60 |
| Max. Negotiated Rate |
$6,554.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,519.20
|
| Rate for Payer: Cash Price |
$4,139.40
|
| Rate for Payer: Cash Price |
$4,139.40
|
| Rate for Payer: Cigna Commercial |
$5,864.15
|
| Rate for Payer: First Health Commercial |
$6,209.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,209.10
|
| Rate for Payer: GEHA Commercial |
$4,829.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,209.10
|
| Rate for Payer: Multiplan All |
$6,278.09
|
| Rate for Payer: OMNI Networks Commercial |
$4,829.30
|
| Rate for Payer: One Health Plan PPO/POS |
$6,209.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,554.05
|
| Rate for Payer: Three Rivers Provider Network All |
$5,174.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,416.07
|
| Rate for Payer: Zelis Auto |
$2,759.60
|
|
|
IMPLT GLENOSPHERE ECCENTRIC 2MM 36MM 2MM
|
Facility
|
OP
|
$6,899.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003325
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,724.75 |
| Max. Negotiated Rate |
$6,554.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,139.40
|
| Rate for Payer: Cash Price |
$4,139.40
|
| Rate for Payer: Cash Price |
$4,139.40
|
| Rate for Payer: Cigna Commercial |
$5,864.15
|
| Rate for Payer: First Health Commercial |
$6,209.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,209.10
|
| Rate for Payer: GEHA Commercial |
$5,519.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,209.10
|
| Rate for Payer: Humana ChoiceCare |
$1,793.74
|
| Rate for Payer: Multiplan All |
$6,278.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,139.40
|
| Rate for Payer: OMNI Networks Commercial |
$4,829.30
|
| Rate for Payer: One Health Plan PPO/POS |
$6,209.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,554.05
|
| Rate for Payer: Three Rivers Provider Network All |
$5,174.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,071.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,724.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,416.07
|
| Rate for Payer: Zelis Auto |
$2,759.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,449.50
|
|
|
IMPLT GLENOSPHERE ECCENTRIC 2MM 40MM 6MM
|
Facility
|
OP
|
$6,899.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003290
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,724.75 |
| Max. Negotiated Rate |
$6,554.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,139.40
|
| Rate for Payer: Cash Price |
$4,139.40
|
| Rate for Payer: Cash Price |
$4,139.40
|
| Rate for Payer: Cigna Commercial |
$5,864.15
|
| Rate for Payer: First Health Commercial |
$6,209.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,209.10
|
| Rate for Payer: GEHA Commercial |
$5,519.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,209.10
|
| Rate for Payer: Humana ChoiceCare |
$1,793.74
|
| Rate for Payer: Multiplan All |
$6,278.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,139.40
|
| Rate for Payer: OMNI Networks Commercial |
$4,829.30
|
| Rate for Payer: One Health Plan PPO/POS |
$6,209.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,554.05
|
| Rate for Payer: Three Rivers Provider Network All |
$5,174.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,071.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,724.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,416.07
|
| Rate for Payer: Zelis Auto |
$2,759.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,449.50
|
|
|
IMPLT GLENOSPHERE ECCENTRIC 2MM 40MM 6MM
|
Facility
|
IP
|
$6,899.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003290
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,759.60 |
| Max. Negotiated Rate |
$6,554.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,519.20
|
| Rate for Payer: Cash Price |
$4,139.40
|
| Rate for Payer: Cash Price |
$4,139.40
|
| Rate for Payer: Cigna Commercial |
$5,864.15
|
| Rate for Payer: First Health Commercial |
$6,209.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,209.10
|
| Rate for Payer: GEHA Commercial |
$4,829.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,209.10
|
| Rate for Payer: Multiplan All |
$6,278.09
|
| Rate for Payer: OMNI Networks Commercial |
$4,829.30
|
| Rate for Payer: One Health Plan PPO/POS |
$6,209.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,554.05
|
| Rate for Payer: Three Rivers Provider Network All |
$5,174.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,416.07
|
| Rate for Payer: Zelis Auto |
$2,759.60
|
|
|
IMPLT GLENOSPHERE STANDARD 36MM
|
Facility
|
IP
|
$6,592.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001993
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,636.80 |
| Max. Negotiated Rate |
$6,262.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,273.60
|
| Rate for Payer: Cash Price |
$3,955.20
|
| Rate for Payer: Cash Price |
$3,955.20
|
| Rate for Payer: Cigna Commercial |
$5,603.20
|
| Rate for Payer: First Health Commercial |
$5,932.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,932.80
|
| Rate for Payer: GEHA Commercial |
$4,614.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,932.80
|
| Rate for Payer: Multiplan All |
$5,998.72
|
| Rate for Payer: OMNI Networks Commercial |
$4,614.40
|
| Rate for Payer: One Health Plan PPO/POS |
$5,932.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,262.40
|
| Rate for Payer: Three Rivers Provider Network All |
$4,944.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,130.56
|
| Rate for Payer: Zelis Auto |
$2,636.80
|
|
|
IMPLT GLENOSPHERE STANDARD 36MM
|
Facility
|
OP
|
$6,592.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001993
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,648.00 |
| Max. Negotiated Rate |
$6,262.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,955.20
|
| Rate for Payer: Cash Price |
$3,955.20
|
| Rate for Payer: Cash Price |
$3,955.20
|
| Rate for Payer: Cigna Commercial |
$5,603.20
|
| Rate for Payer: First Health Commercial |
$5,932.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,932.80
|
| Rate for Payer: GEHA Commercial |
$5,273.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,932.80
|
| Rate for Payer: Humana ChoiceCare |
$1,713.92
|
| Rate for Payer: Multiplan All |
$5,998.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,955.20
|
| Rate for Payer: OMNI Networks Commercial |
$4,614.40
|
| Rate for Payer: One Health Plan PPO/POS |
$5,932.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,262.40
|
| Rate for Payer: Three Rivers Provider Network All |
$4,944.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,800.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,648.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,130.56
|
| Rate for Payer: Zelis Auto |
$2,636.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,296.00
|
|
|
IMPLT GOLDENBURG INCUS PROSTHESIS
|
Facility
|
OP
|
$2,138.00
|
|
|
Service Code
|
CPT L8613
|
| Hospital Charge Code |
7006503
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$534.50 |
| Max. Negotiated Rate |
$2,031.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,282.80
|
| Rate for Payer: Cash Price |
$1,282.80
|
| Rate for Payer: Cash Price |
$1,282.80
|
| Rate for Payer: Cigna Commercial |
$1,817.30
|
| Rate for Payer: First Health Commercial |
$1,924.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,924.20
|
| Rate for Payer: GEHA Commercial |
$1,710.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,924.20
|
| Rate for Payer: Humana ChoiceCare |
$555.88
|
| Rate for Payer: Multiplan All |
$1,945.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,282.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,496.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,924.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,031.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,603.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,881.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$534.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,988.34
|
| Rate for Payer: Zelis Auto |
$855.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,069.00
|
|
|
IMPLT GOLDENBURG INCUS PROSTHESIS
|
Facility
|
IP
|
$2,138.00
|
|
|
Service Code
|
CPT L8613
|
| Hospital Charge Code |
7006503
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$855.20 |
| Max. Negotiated Rate |
$2,031.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,710.40
|
| Rate for Payer: Cash Price |
$1,282.80
|
| Rate for Payer: Cash Price |
$1,282.80
|
| Rate for Payer: Cigna Commercial |
$1,817.30
|
| Rate for Payer: First Health Commercial |
$1,924.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,924.20
|
| Rate for Payer: GEHA Commercial |
$1,496.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,924.20
|
| Rate for Payer: Multiplan All |
$1,945.58
|
| Rate for Payer: OMNI Networks Commercial |
$1,496.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,924.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,031.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,603.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,988.34
|
| Rate for Payer: Zelis Auto |
$855.20
|
|
|
IMPLT GOLDENBURG INCUS STAPES
|
Facility
|
OP
|
$2,142.00
|
|
|
Service Code
|
CPT L8613
|
| Hospital Charge Code |
7006504
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$535.50 |
| Max. Negotiated Rate |
$2,034.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,285.20
|
| Rate for Payer: Cash Price |
$1,285.20
|
| Rate for Payer: Cash Price |
$1,285.20
|
| Rate for Payer: Cigna Commercial |
$1,820.70
|
| Rate for Payer: First Health Commercial |
$1,927.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,927.80
|
| Rate for Payer: GEHA Commercial |
$1,713.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,927.80
|
| Rate for Payer: Humana ChoiceCare |
$556.92
|
| Rate for Payer: Multiplan All |
$1,949.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,285.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,499.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,927.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,034.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,606.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,884.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$535.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,992.06
|
| Rate for Payer: Zelis Auto |
$856.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,071.00
|
|
|
IMPLT GOLDENBURG INCUS STAPES
|
Facility
|
IP
|
$2,142.00
|
|
|
Service Code
|
CPT L8613
|
| Hospital Charge Code |
7006504
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$856.80 |
| Max. Negotiated Rate |
$2,034.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,713.60
|
| Rate for Payer: Cash Price |
$1,285.20
|
| Rate for Payer: Cash Price |
$1,285.20
|
| Rate for Payer: Cigna Commercial |
$1,820.70
|
| Rate for Payer: First Health Commercial |
$1,927.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,927.80
|
| Rate for Payer: GEHA Commercial |
$1,499.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,927.80
|
| Rate for Payer: Multiplan All |
$1,949.22
|
| Rate for Payer: OMNI Networks Commercial |
$1,499.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,927.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,034.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,606.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,992.06
|
| Rate for Payer: Zelis Auto |
$856.80
|
|
|
IMPLT GRAFT BONE ILIAC TRICORTICAL
|
Facility
|
OP
|
$2,225.00
|
|
|
Service Code
|
CPT C9359
|
| Hospital Charge Code |
7006621
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$556.25 |
| Max. Negotiated Rate |
$2,113.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,335.00
|
| Rate for Payer: Cash Price |
$1,335.00
|
| Rate for Payer: Cash Price |
$1,335.00
|
| Rate for Payer: Cigna Commercial |
$1,891.25
|
| Rate for Payer: First Health Commercial |
$2,002.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,002.50
|
| Rate for Payer: GEHA Commercial |
$1,780.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,002.50
|
| Rate for Payer: Humana ChoiceCare |
$578.50
|
| Rate for Payer: Multiplan All |
$2,024.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,335.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,557.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,002.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,113.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,668.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,958.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$556.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,069.25
|
| Rate for Payer: Zelis Auto |
$890.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,112.50
|
|
|
IMPLT GRAFT BONE ILIAC TRICORTICAL
|
Facility
|
IP
|
$2,225.00
|
|
|
Service Code
|
CPT C9359
|
| Hospital Charge Code |
7006621
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$890.00 |
| Max. Negotiated Rate |
$2,113.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,780.00
|
| Rate for Payer: Cash Price |
$1,335.00
|
| Rate for Payer: Cash Price |
$1,335.00
|
| Rate for Payer: Cigna Commercial |
$1,891.25
|
| Rate for Payer: First Health Commercial |
$2,002.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,002.50
|
| Rate for Payer: GEHA Commercial |
$1,557.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,002.50
|
| Rate for Payer: Multiplan All |
$2,024.75
|
| Rate for Payer: OMNI Networks Commercial |
$1,557.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,002.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,113.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,668.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,069.25
|
| Rate for Payer: Zelis Auto |
$890.00
|
|
|
IMPLT GRAFT BONE ILIAC TRICORTICAL
|
Facility
|
IP
|
$3,208.00
|
|
|
Service Code
|
CPT C9359
|
| Hospital Charge Code |
7006100
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,283.20 |
| Max. Negotiated Rate |
$3,047.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,566.40
|
| Rate for Payer: Cash Price |
$1,924.80
|
| Rate for Payer: Cash Price |
$1,924.80
|
| Rate for Payer: Cigna Commercial |
$2,726.80
|
| Rate for Payer: First Health Commercial |
$2,887.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,887.20
|
| Rate for Payer: GEHA Commercial |
$2,245.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,887.20
|
| Rate for Payer: Multiplan All |
$2,919.28
|
| Rate for Payer: OMNI Networks Commercial |
$2,245.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,887.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,047.60
|
| Rate for Payer: Three Rivers Provider Network All |
$2,406.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,983.44
|
| Rate for Payer: Zelis Auto |
$1,283.20
|
|
|
IMPLT GRAFT BONE ILIAC TRICORTICAL
|
Facility
|
OP
|
$3,208.00
|
|
|
Service Code
|
CPT C9359
|
| Hospital Charge Code |
7006100
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$802.00 |
| Max. Negotiated Rate |
$3,047.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,924.80
|
| Rate for Payer: Cash Price |
$1,924.80
|
| Rate for Payer: Cash Price |
$1,924.80
|
| Rate for Payer: Cigna Commercial |
$2,726.80
|
| Rate for Payer: First Health Commercial |
$2,887.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,887.20
|
| Rate for Payer: GEHA Commercial |
$2,566.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,887.20
|
| Rate for Payer: Humana ChoiceCare |
$834.08
|
| Rate for Payer: Multiplan All |
$2,919.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,924.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,245.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,887.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,047.60
|
| Rate for Payer: Three Rivers Provider Network All |
$2,406.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,823.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$802.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,983.44
|
| Rate for Payer: Zelis Auto |
$1,283.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,604.00
|
|
|
IMPLT GRAFT BONE SUBSTITUTE 10CC
|
Facility
|
IP
|
$2,797.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000283
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,118.80 |
| Max. Negotiated Rate |
$2,657.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,237.60
|
| Rate for Payer: Cash Price |
$1,678.20
|
| Rate for Payer: Cash Price |
$1,678.20
|
| Rate for Payer: Cigna Commercial |
$2,377.45
|
| Rate for Payer: First Health Commercial |
$2,517.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,517.30
|
| Rate for Payer: GEHA Commercial |
$1,957.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,517.30
|
| Rate for Payer: Multiplan All |
$2,545.27
|
| Rate for Payer: OMNI Networks Commercial |
$1,957.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,517.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,657.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,097.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,601.21
|
| Rate for Payer: Zelis Auto |
$1,118.80
|
|
|
IMPLT GRAFT BONE SUBSTITUTE 10CC
|
Facility
|
OP
|
$2,797.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000283
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$699.25 |
| Max. Negotiated Rate |
$2,657.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,678.20
|
| Rate for Payer: Cash Price |
$1,678.20
|
| Rate for Payer: Cash Price |
$1,678.20
|
| Rate for Payer: Cigna Commercial |
$2,377.45
|
| Rate for Payer: First Health Commercial |
$2,517.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,517.30
|
| Rate for Payer: GEHA Commercial |
$2,237.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,517.30
|
| Rate for Payer: Humana ChoiceCare |
$727.22
|
| Rate for Payer: Multiplan All |
$2,545.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,678.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,957.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,517.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,657.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,097.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,461.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$699.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,601.21
|
| Rate for Payer: Zelis Auto |
$1,118.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,398.50
|
|
|
IMPLT GRAFT BONE VITOSS 15CC
|
Facility
|
OP
|
$3,604.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003092
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$901.00 |
| Max. Negotiated Rate |
$3,423.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,162.40
|
| Rate for Payer: Cash Price |
$2,162.40
|
| Rate for Payer: Cash Price |
$2,162.40
|
| Rate for Payer: Cigna Commercial |
$3,063.40
|
| Rate for Payer: First Health Commercial |
$3,243.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,243.60
|
| Rate for Payer: GEHA Commercial |
$2,883.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,243.60
|
| Rate for Payer: Humana ChoiceCare |
$937.04
|
| Rate for Payer: Multiplan All |
$3,279.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,162.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,522.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,243.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,423.80
|
| Rate for Payer: Three Rivers Provider Network All |
$2,703.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,171.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$901.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,351.72
|
| Rate for Payer: Zelis Auto |
$1,441.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,802.00
|
|
|
IMPLT GRAFT BONE VITOSS 15CC
|
Facility
|
IP
|
$3,604.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003092
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,441.60 |
| Max. Negotiated Rate |
$3,423.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,883.20
|
| Rate for Payer: Cash Price |
$2,162.40
|
| Rate for Payer: Cash Price |
$2,162.40
|
| Rate for Payer: Cigna Commercial |
$3,063.40
|
| Rate for Payer: First Health Commercial |
$3,243.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,243.60
|
| Rate for Payer: GEHA Commercial |
$2,522.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,243.60
|
| Rate for Payer: Multiplan All |
$3,279.64
|
| Rate for Payer: OMNI Networks Commercial |
$2,522.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,243.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,423.80
|
| Rate for Payer: Three Rivers Provider Network All |
$2,703.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,351.72
|
| Rate for Payer: Zelis Auto |
$1,441.60
|
|
|
IMPLT GRAFT BONE VITOSS 30CC
|
Facility
|
IP
|
$7,253.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000284
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,901.20 |
| Max. Negotiated Rate |
$6,890.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,802.40
|
| Rate for Payer: Cash Price |
$4,351.80
|
| Rate for Payer: Cash Price |
$4,351.80
|
| Rate for Payer: Cigna Commercial |
$6,165.05
|
| Rate for Payer: First Health Commercial |
$6,527.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,527.70
|
| Rate for Payer: GEHA Commercial |
$5,077.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,527.70
|
| Rate for Payer: Multiplan All |
$6,600.23
|
| Rate for Payer: OMNI Networks Commercial |
$5,077.10
|
| Rate for Payer: One Health Plan PPO/POS |
$6,527.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,890.35
|
| Rate for Payer: Three Rivers Provider Network All |
$5,439.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,745.29
|
| Rate for Payer: Zelis Auto |
$2,901.20
|
|
