|
IMPLT HEAD BIPOLAR 44MM UNIVERSAL
|
Facility
|
OP
|
$2,225.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001848
|
|
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 HEAD BIPOLAR UNIVERSAL 52MM
|
Facility
|
IP
|
$8,069.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001994
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,227.60 |
| Max. Negotiated Rate |
$7,665.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,455.20
|
| Rate for Payer: Cash Price |
$4,841.40
|
| Rate for Payer: Cash Price |
$4,841.40
|
| Rate for Payer: Cigna Commercial |
$6,858.65
|
| Rate for Payer: First Health Commercial |
$7,262.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,262.10
|
| Rate for Payer: GEHA Commercial |
$5,648.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,262.10
|
| Rate for Payer: Multiplan All |
$7,342.79
|
| Rate for Payer: OMNI Networks Commercial |
$5,648.30
|
| Rate for Payer: One Health Plan PPO/POS |
$7,262.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,665.55
|
| Rate for Payer: Three Rivers Provider Network All |
$6,051.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,504.17
|
| Rate for Payer: Zelis Auto |
$3,227.60
|
|
|
IMPLT HEAD BIPOLAR UNIVERSAL 52MM
|
Facility
|
OP
|
$8,069.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001994
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,017.25 |
| Max. Negotiated Rate |
$7,665.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,841.40
|
| Rate for Payer: Cash Price |
$4,841.40
|
| Rate for Payer: Cash Price |
$4,841.40
|
| Rate for Payer: Cigna Commercial |
$6,858.65
|
| Rate for Payer: First Health Commercial |
$7,262.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,262.10
|
| Rate for Payer: GEHA Commercial |
$6,455.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,262.10
|
| Rate for Payer: Humana ChoiceCare |
$2,097.94
|
| Rate for Payer: Multiplan All |
$7,342.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,841.40
|
| Rate for Payer: OMNI Networks Commercial |
$5,648.30
|
| Rate for Payer: One Health Plan PPO/POS |
$7,262.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,665.55
|
| Rate for Payer: Three Rivers Provider Network All |
$6,051.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,100.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,017.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,504.17
|
| Rate for Payer: Zelis Auto |
$3,227.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,034.50
|
|
|
IMPLT HEAD CERAMIC BIOLOX 28X-4MM
|
Facility
|
IP
|
$2,588.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7005216
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,035.20 |
| Max. Negotiated Rate |
$2,458.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,070.40
|
| Rate for Payer: Cash Price |
$1,552.80
|
| Rate for Payer: Cash Price |
$1,552.80
|
| Rate for Payer: Cigna Commercial |
$2,199.80
|
| Rate for Payer: First Health Commercial |
$2,329.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,329.20
|
| Rate for Payer: GEHA Commercial |
$1,811.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,329.20
|
| Rate for Payer: Multiplan All |
$2,355.08
|
| Rate for Payer: OMNI Networks Commercial |
$1,811.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,329.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,458.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,941.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,406.84
|
| Rate for Payer: Zelis Auto |
$1,035.20
|
|
|
IMPLT HEAD CERAMIC BIOLOX 28X-4MM
|
Facility
|
OP
|
$2,588.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7005216
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.00 |
| Max. Negotiated Rate |
$2,458.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,552.80
|
| Rate for Payer: Cash Price |
$1,552.80
|
| Rate for Payer: Cash Price |
$1,552.80
|
| Rate for Payer: Cigna Commercial |
$2,199.80
|
| Rate for Payer: First Health Commercial |
$2,329.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,329.20
|
| Rate for Payer: GEHA Commercial |
$2,070.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,329.20
|
| Rate for Payer: Humana ChoiceCare |
$672.88
|
| Rate for Payer: Multiplan All |
$2,355.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,552.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,811.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,329.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,458.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,941.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,277.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$647.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,406.84
|
| Rate for Payer: Zelis Auto |
$1,035.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,294.00
|
|
|
IMPLT HEAD CERAMIC BIOLOX 36X-5MM
|
Facility
|
IP
|
$2,588.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,035.20 |
| Max. Negotiated Rate |
$2,458.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,070.40
|
| Rate for Payer: Cash Price |
$1,552.80
|
| Rate for Payer: Cash Price |
$1,552.80
|
| Rate for Payer: Cigna Commercial |
$2,199.80
|
| Rate for Payer: First Health Commercial |
$2,329.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,329.20
|
| Rate for Payer: GEHA Commercial |
$1,811.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,329.20
|
| Rate for Payer: Multiplan All |
$2,355.08
|
| Rate for Payer: OMNI Networks Commercial |
$1,811.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,329.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,458.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,941.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,406.84
|
| Rate for Payer: Zelis Auto |
$1,035.20
|
|
|
IMPLT HEAD CERAMIC BIOLOX 36X-5MM
|
Facility
|
OP
|
$2,588.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.00 |
| Max. Negotiated Rate |
$2,458.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,552.80
|
| Rate for Payer: Cash Price |
$1,552.80
|
| Rate for Payer: Cash Price |
$1,552.80
|
| Rate for Payer: Cigna Commercial |
$2,199.80
|
| Rate for Payer: First Health Commercial |
$2,329.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,329.20
|
| Rate for Payer: GEHA Commercial |
$2,070.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,329.20
|
| Rate for Payer: Humana ChoiceCare |
$672.88
|
| Rate for Payer: Multiplan All |
$2,355.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,552.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,811.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,329.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,458.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,941.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,277.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$647.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,406.84
|
| Rate for Payer: Zelis Auto |
$1,035.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,294.00
|
|
|
IMPLT HEAD CERAMIC FEMORAL 36MMX+5
|
Facility
|
OP
|
$2,588.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001995
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.00 |
| Max. Negotiated Rate |
$2,458.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,552.80
|
| Rate for Payer: Cash Price |
$1,552.80
|
| Rate for Payer: Cash Price |
$1,552.80
|
| Rate for Payer: Cigna Commercial |
$2,199.80
|
| Rate for Payer: First Health Commercial |
$2,329.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,329.20
|
| Rate for Payer: GEHA Commercial |
$2,070.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,329.20
|
| Rate for Payer: Humana ChoiceCare |
$672.88
|
| Rate for Payer: Multiplan All |
$2,355.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,552.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,811.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,329.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,458.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,941.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,277.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$647.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,406.84
|
| Rate for Payer: Zelis Auto |
$1,035.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,294.00
|
|
|
IMPLT HEAD CERAMIC FEMORAL 36MMX+5
|
Facility
|
IP
|
$2,588.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001995
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,035.20 |
| Max. Negotiated Rate |
$2,458.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,070.40
|
| Rate for Payer: Cash Price |
$1,552.80
|
| Rate for Payer: Cash Price |
$1,552.80
|
| Rate for Payer: Cigna Commercial |
$2,199.80
|
| Rate for Payer: First Health Commercial |
$2,329.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,329.20
|
| Rate for Payer: GEHA Commercial |
$1,811.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,329.20
|
| Rate for Payer: Multiplan All |
$2,355.08
|
| Rate for Payer: OMNI Networks Commercial |
$1,811.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,329.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,458.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,941.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,406.84
|
| Rate for Payer: Zelis Auto |
$1,035.20
|
|
|
IMPLT HEAD COMPONENT 49MM
|
Facility
|
IP
|
$2,078.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006715
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$831.20 |
| Max. Negotiated Rate |
$1,974.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,662.40
|
| Rate for Payer: Cash Price |
$1,246.80
|
| Rate for Payer: Cash Price |
$1,246.80
|
| Rate for Payer: Cigna Commercial |
$1,766.30
|
| Rate for Payer: First Health Commercial |
$1,870.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,870.20
|
| Rate for Payer: GEHA Commercial |
$1,454.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,870.20
|
| Rate for Payer: Multiplan All |
$1,890.98
|
| Rate for Payer: OMNI Networks Commercial |
$1,454.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,870.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,974.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,558.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,932.54
|
| Rate for Payer: Zelis Auto |
$831.20
|
|
|
IMPLT HEAD COMPONENT 49MM
|
Facility
|
OP
|
$2,078.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006715
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$519.50 |
| Max. Negotiated Rate |
$1,974.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,246.80
|
| Rate for Payer: Cash Price |
$1,246.80
|
| Rate for Payer: Cash Price |
$1,246.80
|
| Rate for Payer: Cigna Commercial |
$1,766.30
|
| Rate for Payer: First Health Commercial |
$1,870.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,870.20
|
| Rate for Payer: GEHA Commercial |
$1,662.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,870.20
|
| Rate for Payer: Humana ChoiceCare |
$540.28
|
| Rate for Payer: Multiplan All |
$1,890.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,246.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,454.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,870.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,974.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,558.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,828.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$519.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,932.54
|
| Rate for Payer: Zelis Auto |
$831.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,039.00
|
|
|
IMPLT HEAD COMPONENT 55MM
|
Facility
|
OP
|
$2,078.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006691
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$519.50 |
| Max. Negotiated Rate |
$1,974.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,246.80
|
| Rate for Payer: Cash Price |
$1,246.80
|
| Rate for Payer: Cash Price |
$1,246.80
|
| Rate for Payer: Cigna Commercial |
$1,766.30
|
| Rate for Payer: First Health Commercial |
$1,870.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,870.20
|
| Rate for Payer: GEHA Commercial |
$1,662.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,870.20
|
| Rate for Payer: Humana ChoiceCare |
$540.28
|
| Rate for Payer: Multiplan All |
$1,890.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,246.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,454.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,870.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,974.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,558.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,828.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$519.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,932.54
|
| Rate for Payer: Zelis Auto |
$831.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,039.00
|
|
|
IMPLT HEAD COMPONENT 55MM
|
Facility
|
IP
|
$2,078.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006691
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$831.20 |
| Max. Negotiated Rate |
$1,974.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,662.40
|
| Rate for Payer: Cash Price |
$1,246.80
|
| Rate for Payer: Cash Price |
$1,246.80
|
| Rate for Payer: Cigna Commercial |
$1,766.30
|
| Rate for Payer: First Health Commercial |
$1,870.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,870.20
|
| Rate for Payer: GEHA Commercial |
$1,454.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,870.20
|
| Rate for Payer: Multiplan All |
$1,890.98
|
| Rate for Payer: OMNI Networks Commercial |
$1,454.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,870.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,974.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,558.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,932.54
|
| Rate for Payer: Zelis Auto |
$831.20
|
|
|
IMPLT HEAD C-TAPER SIZE 22MM +5
|
Facility
|
IP
|
$2,081.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001849
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$832.40 |
| Max. Negotiated Rate |
$1,976.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,664.80
|
| Rate for Payer: Cash Price |
$1,248.60
|
| Rate for Payer: Cash Price |
$1,248.60
|
| Rate for Payer: Cigna Commercial |
$1,768.85
|
| Rate for Payer: First Health Commercial |
$1,872.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,872.90
|
| Rate for Payer: GEHA Commercial |
$1,456.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,872.90
|
| Rate for Payer: Multiplan All |
$1,893.71
|
| Rate for Payer: OMNI Networks Commercial |
$1,456.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,872.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,976.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,560.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,935.33
|
| Rate for Payer: Zelis Auto |
$832.40
|
|
|
IMPLT HEAD C-TAPER SIZE 22MM +5
|
Facility
|
OP
|
$2,081.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001849
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$520.25 |
| Max. Negotiated Rate |
$1,976.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,248.60
|
| Rate for Payer: Cash Price |
$1,248.60
|
| Rate for Payer: Cash Price |
$1,248.60
|
| Rate for Payer: Cigna Commercial |
$1,768.85
|
| Rate for Payer: First Health Commercial |
$1,872.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,872.90
|
| Rate for Payer: GEHA Commercial |
$1,664.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,872.90
|
| Rate for Payer: Humana ChoiceCare |
$541.06
|
| Rate for Payer: Multiplan All |
$1,893.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,248.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,456.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,872.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,976.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,560.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,831.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$520.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,935.33
|
| Rate for Payer: Zelis Auto |
$832.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,040.50
|
|
|
IMPLT HEADED SCREW 2.5MM 24MM
|
Facility
|
OP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009203
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$288.00 |
| Max. Negotiated Rate |
$1,094.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cigna Commercial |
$979.20
|
| Rate for Payer: First Health Commercial |
$1,036.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,036.80
|
| Rate for Payer: GEHA Commercial |
$921.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,036.80
|
| Rate for Payer: Humana ChoiceCare |
$299.52
|
| Rate for Payer: Multiplan All |
$1,048.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$691.20
|
| Rate for Payer: OMNI Networks Commercial |
$806.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,036.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,094.40
|
| Rate for Payer: Three Rivers Provider Network All |
$864.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,013.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$288.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,071.36
|
| Rate for Payer: Zelis Auto |
$460.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$576.00
|
|
|
IMPLT HEADED SCREW 2.5MM 24MM
|
Facility
|
IP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009203
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$460.80 |
| Max. Negotiated Rate |
$1,094.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$921.60
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cigna Commercial |
$979.20
|
| Rate for Payer: First Health Commercial |
$1,036.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,036.80
|
| Rate for Payer: GEHA Commercial |
$806.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,036.80
|
| Rate for Payer: Multiplan All |
$1,048.32
|
| Rate for Payer: OMNI Networks Commercial |
$806.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,036.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,094.40
|
| Rate for Payer: Three Rivers Provider Network All |
$864.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,071.36
|
| Rate for Payer: Zelis Auto |
$460.80
|
|
|
IMPLT HEADED SCREW 2.5MM X 10MM
|
Facility
|
IP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009097
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$460.80 |
| Max. Negotiated Rate |
$1,094.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$921.60
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cigna Commercial |
$979.20
|
| Rate for Payer: First Health Commercial |
$1,036.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,036.80
|
| Rate for Payer: GEHA Commercial |
$806.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,036.80
|
| Rate for Payer: Multiplan All |
$1,048.32
|
| Rate for Payer: OMNI Networks Commercial |
$806.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,036.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,094.40
|
| Rate for Payer: Three Rivers Provider Network All |
$864.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,071.36
|
| Rate for Payer: Zelis Auto |
$460.80
|
|
|
IMPLT HEADED SCREW 2.5MM X 10MM
|
Facility
|
OP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009097
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$288.00 |
| Max. Negotiated Rate |
$1,094.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cigna Commercial |
$979.20
|
| Rate for Payer: First Health Commercial |
$1,036.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,036.80
|
| Rate for Payer: GEHA Commercial |
$921.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,036.80
|
| Rate for Payer: Humana ChoiceCare |
$299.52
|
| Rate for Payer: Multiplan All |
$1,048.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$691.20
|
| Rate for Payer: OMNI Networks Commercial |
$806.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,036.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,094.40
|
| Rate for Payer: Three Rivers Provider Network All |
$864.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,013.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$288.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,071.36
|
| Rate for Payer: Zelis Auto |
$460.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$576.00
|
|
|
IMPLT HEADED SCREW 2.5MM X 12MM
|
Facility
|
IP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009098
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$460.80 |
| Max. Negotiated Rate |
$1,094.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$921.60
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cigna Commercial |
$979.20
|
| Rate for Payer: First Health Commercial |
$1,036.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,036.80
|
| Rate for Payer: GEHA Commercial |
$806.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,036.80
|
| Rate for Payer: Multiplan All |
$1,048.32
|
| Rate for Payer: OMNI Networks Commercial |
$806.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,036.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,094.40
|
| Rate for Payer: Three Rivers Provider Network All |
$864.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,071.36
|
| Rate for Payer: Zelis Auto |
$460.80
|
|
|
IMPLT HEADED SCREW 2.5MM X 12MM
|
Facility
|
OP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009098
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$288.00 |
| Max. Negotiated Rate |
$1,094.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cigna Commercial |
$979.20
|
| Rate for Payer: First Health Commercial |
$1,036.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,036.80
|
| Rate for Payer: GEHA Commercial |
$921.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,036.80
|
| Rate for Payer: Humana ChoiceCare |
$299.52
|
| Rate for Payer: Multiplan All |
$1,048.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$691.20
|
| Rate for Payer: OMNI Networks Commercial |
$806.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,036.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,094.40
|
| Rate for Payer: Three Rivers Provider Network All |
$864.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,013.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$288.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,071.36
|
| Rate for Payer: Zelis Auto |
$460.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$576.00
|
|
|
IMPLT HEADED SCREW 2.5MM X 14MM
|
Facility
|
OP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009099
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$288.00 |
| Max. Negotiated Rate |
$1,094.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cigna Commercial |
$979.20
|
| Rate for Payer: First Health Commercial |
$1,036.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,036.80
|
| Rate for Payer: GEHA Commercial |
$921.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,036.80
|
| Rate for Payer: Humana ChoiceCare |
$299.52
|
| Rate for Payer: Multiplan All |
$1,048.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$691.20
|
| Rate for Payer: OMNI Networks Commercial |
$806.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,036.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,094.40
|
| Rate for Payer: Three Rivers Provider Network All |
$864.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,013.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$288.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,071.36
|
| Rate for Payer: Zelis Auto |
$460.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$576.00
|
|
|
IMPLT HEADED SCREW 2.5MM X 14MM
|
Facility
|
IP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009099
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$460.80 |
| Max. Negotiated Rate |
$1,094.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$921.60
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cigna Commercial |
$979.20
|
| Rate for Payer: First Health Commercial |
$1,036.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,036.80
|
| Rate for Payer: GEHA Commercial |
$806.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,036.80
|
| Rate for Payer: Multiplan All |
$1,048.32
|
| Rate for Payer: OMNI Networks Commercial |
$806.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,036.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,094.40
|
| Rate for Payer: Three Rivers Provider Network All |
$864.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,071.36
|
| Rate for Payer: Zelis Auto |
$460.80
|
|
|
IMPLT HEADED SCREW 2.5MM X 16MM
|
Facility
|
OP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009100
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$288.00 |
| Max. Negotiated Rate |
$1,094.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cigna Commercial |
$979.20
|
| Rate for Payer: First Health Commercial |
$1,036.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,036.80
|
| Rate for Payer: GEHA Commercial |
$921.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,036.80
|
| Rate for Payer: Humana ChoiceCare |
$299.52
|
| Rate for Payer: Multiplan All |
$1,048.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$691.20
|
| Rate for Payer: OMNI Networks Commercial |
$806.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,036.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,094.40
|
| Rate for Payer: Three Rivers Provider Network All |
$864.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,013.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$288.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,071.36
|
| Rate for Payer: Zelis Auto |
$460.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$576.00
|
|
|
IMPLT HEADED SCREW 2.5MM X 16MM
|
Facility
|
IP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009100
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$460.80 |
| Max. Negotiated Rate |
$1,094.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$921.60
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cigna Commercial |
$979.20
|
| Rate for Payer: First Health Commercial |
$1,036.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,036.80
|
| Rate for Payer: GEHA Commercial |
$806.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,036.80
|
| Rate for Payer: Multiplan All |
$1,048.32
|
| Rate for Payer: OMNI Networks Commercial |
$806.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,036.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,094.40
|
| Rate for Payer: Three Rivers Provider Network All |
$864.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,071.36
|
| Rate for Payer: Zelis Auto |
$460.80
|
|
