|
IMPLT HEADED SCREW 4.0MM X 50MM
|
Facility
|
IP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009146
|
|
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 4.0MM X 50MM
|
Facility
|
OP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009146
|
|
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 HEAD EXPLOR 12X22MM
|
Facility
|
IP
|
$5,877.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,350.80 |
| Max. Negotiated Rate |
$5,583.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,701.60
|
| Rate for Payer: Cash Price |
$3,526.20
|
| Rate for Payer: Cash Price |
$3,526.20
|
| Rate for Payer: Cigna Commercial |
$4,995.45
|
| Rate for Payer: First Health Commercial |
$5,289.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,289.30
|
| Rate for Payer: GEHA Commercial |
$4,113.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,289.30
|
| Rate for Payer: Multiplan All |
$5,348.07
|
| Rate for Payer: OMNI Networks Commercial |
$4,113.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,289.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,583.15
|
| Rate for Payer: Three Rivers Provider Network All |
$4,407.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,465.61
|
| Rate for Payer: Zelis Auto |
$2,350.80
|
|
|
IMPLT HEAD EXPLOR 12X22MM
|
Facility
|
OP
|
$5,877.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,469.25 |
| Max. Negotiated Rate |
$5,583.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,526.20
|
| Rate for Payer: Cash Price |
$3,526.20
|
| Rate for Payer: Cash Price |
$3,526.20
|
| Rate for Payer: Cigna Commercial |
$4,995.45
|
| Rate for Payer: First Health Commercial |
$5,289.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,289.30
|
| Rate for Payer: GEHA Commercial |
$4,701.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,289.30
|
| Rate for Payer: Humana ChoiceCare |
$1,528.02
|
| Rate for Payer: Multiplan All |
$5,348.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,526.20
|
| Rate for Payer: OMNI Networks Commercial |
$4,113.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,289.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,583.15
|
| Rate for Payer: Three Rivers Provider Network All |
$4,407.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,171.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,469.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,465.61
|
| Rate for Payer: Zelis Auto |
$2,350.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,938.50
|
|
|
IMPLT HEAD FEMORAL 12/14
|
Facility
|
OP
|
$2,482.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001845
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$620.50 |
| Max. Negotiated Rate |
$2,357.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,489.20
|
| Rate for Payer: Cash Price |
$1,489.20
|
| Rate for Payer: Cash Price |
$1,489.20
|
| Rate for Payer: Cigna Commercial |
$2,109.70
|
| Rate for Payer: First Health Commercial |
$2,233.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,233.80
|
| Rate for Payer: GEHA Commercial |
$1,985.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,233.80
|
| Rate for Payer: Humana ChoiceCare |
$645.32
|
| Rate for Payer: Multiplan All |
$2,258.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,489.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,737.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,233.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,357.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,861.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,184.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$620.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,308.26
|
| Rate for Payer: Zelis Auto |
$992.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,241.00
|
|
|
IMPLT HEAD FEMORAL 12/14
|
Facility
|
IP
|
$2,482.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001845
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$992.80 |
| Max. Negotiated Rate |
$2,357.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,985.60
|
| Rate for Payer: Cash Price |
$1,489.20
|
| Rate for Payer: Cash Price |
$1,489.20
|
| Rate for Payer: Cigna Commercial |
$2,109.70
|
| Rate for Payer: First Health Commercial |
$2,233.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,233.80
|
| Rate for Payer: GEHA Commercial |
$1,737.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,233.80
|
| Rate for Payer: Multiplan All |
$2,258.62
|
| Rate for Payer: OMNI Networks Commercial |
$1,737.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,233.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,357.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,861.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,308.26
|
| Rate for Payer: Zelis Auto |
$992.80
|
|
|
IMPLT HEAD FEMORAL 12/14 28MM+8
|
Facility
|
OP
|
$6,547.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001853
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,636.75 |
| Max. Negotiated Rate |
$6,219.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,928.20
|
| Rate for Payer: Cash Price |
$3,928.20
|
| Rate for Payer: Cash Price |
$3,928.20
|
| Rate for Payer: Cigna Commercial |
$5,564.95
|
| Rate for Payer: First Health Commercial |
$5,892.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,892.30
|
| Rate for Payer: GEHA Commercial |
$5,237.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,892.30
|
| Rate for Payer: Humana ChoiceCare |
$1,702.22
|
| Rate for Payer: Multiplan All |
$5,957.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,928.20
|
| Rate for Payer: OMNI Networks Commercial |
$4,582.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,892.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,219.65
|
| Rate for Payer: Three Rivers Provider Network All |
$4,910.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,761.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,636.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,088.71
|
| Rate for Payer: Zelis Auto |
$2,618.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,273.50
|
|
|
IMPLT HEAD FEMORAL 12/14 28MM+8
|
Facility
|
IP
|
$6,547.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001853
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,618.80 |
| Max. Negotiated Rate |
$6,219.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,237.60
|
| Rate for Payer: Cash Price |
$3,928.20
|
| Rate for Payer: Cash Price |
$3,928.20
|
| Rate for Payer: Cigna Commercial |
$5,564.95
|
| Rate for Payer: First Health Commercial |
$5,892.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,892.30
|
| Rate for Payer: GEHA Commercial |
$4,582.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,892.30
|
| Rate for Payer: Multiplan All |
$5,957.77
|
| Rate for Payer: OMNI Networks Commercial |
$4,582.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,892.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,219.65
|
| Rate for Payer: Three Rivers Provider Network All |
$4,910.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,088.71
|
| Rate for Payer: Zelis Auto |
$2,618.80
|
|
|
IMPLT HEAD FEMORAL 12/14 36MM
|
Facility
|
IP
|
$5,542.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002026
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,216.80 |
| Max. Negotiated Rate |
$5,264.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,433.60
|
| Rate for Payer: Cash Price |
$3,325.20
|
| Rate for Payer: Cash Price |
$3,325.20
|
| Rate for Payer: Cigna Commercial |
$4,710.70
|
| Rate for Payer: First Health Commercial |
$4,987.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,987.80
|
| Rate for Payer: GEHA Commercial |
$3,879.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,987.80
|
| Rate for Payer: Multiplan All |
$5,043.22
|
| Rate for Payer: OMNI Networks Commercial |
$3,879.40
|
| Rate for Payer: One Health Plan PPO/POS |
$4,987.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,264.90
|
| Rate for Payer: Three Rivers Provider Network All |
$4,156.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,154.06
|
| Rate for Payer: Zelis Auto |
$2,216.80
|
|
|
IMPLT HEAD FEMORAL 12/14 36MM
|
Facility
|
OP
|
$5,542.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002026
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,385.50 |
| Max. Negotiated Rate |
$5,264.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,325.20
|
| Rate for Payer: Cash Price |
$3,325.20
|
| Rate for Payer: Cash Price |
$3,325.20
|
| Rate for Payer: Cigna Commercial |
$4,710.70
|
| Rate for Payer: First Health Commercial |
$4,987.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,987.80
|
| Rate for Payer: GEHA Commercial |
$4,433.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,987.80
|
| Rate for Payer: Humana ChoiceCare |
$1,440.92
|
| Rate for Payer: Multiplan All |
$5,043.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,325.20
|
| Rate for Payer: OMNI Networks Commercial |
$3,879.40
|
| Rate for Payer: One Health Plan PPO/POS |
$4,987.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,264.90
|
| Rate for Payer: Three Rivers Provider Network All |
$4,156.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,876.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,385.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,154.06
|
| Rate for Payer: Zelis Auto |
$2,216.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,771.00
|
|
|
IMPLT HEAD FEMORAL 12/14 OXINIUM
|
Facility
|
OP
|
$5,542.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001850
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,385.50 |
| Max. Negotiated Rate |
$5,264.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,325.20
|
| Rate for Payer: Cash Price |
$3,325.20
|
| Rate for Payer: Cash Price |
$3,325.20
|
| Rate for Payer: Cigna Commercial |
$4,710.70
|
| Rate for Payer: First Health Commercial |
$4,987.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,987.80
|
| Rate for Payer: GEHA Commercial |
$4,433.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,987.80
|
| Rate for Payer: Humana ChoiceCare |
$1,440.92
|
| Rate for Payer: Multiplan All |
$5,043.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,325.20
|
| Rate for Payer: OMNI Networks Commercial |
$3,879.40
|
| Rate for Payer: One Health Plan PPO/POS |
$4,987.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,264.90
|
| Rate for Payer: Three Rivers Provider Network All |
$4,156.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,876.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,385.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,154.06
|
| Rate for Payer: Zelis Auto |
$2,216.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,771.00
|
|
|
IMPLT HEAD FEMORAL 12/14 OXINIUM
|
Facility
|
IP
|
$5,542.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001850
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,216.80 |
| Max. Negotiated Rate |
$5,264.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,433.60
|
| Rate for Payer: Cash Price |
$3,325.20
|
| Rate for Payer: Cash Price |
$3,325.20
|
| Rate for Payer: Cigna Commercial |
$4,710.70
|
| Rate for Payer: First Health Commercial |
$4,987.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,987.80
|
| Rate for Payer: GEHA Commercial |
$3,879.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,987.80
|
| Rate for Payer: Multiplan All |
$5,043.22
|
| Rate for Payer: OMNI Networks Commercial |
$3,879.40
|
| Rate for Payer: One Health Plan PPO/POS |
$4,987.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,264.90
|
| Rate for Payer: Three Rivers Provider Network All |
$4,156.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,154.06
|
| Rate for Payer: Zelis Auto |
$2,216.80
|
|
|
IMPLT HEAD FEMORAL 22.2MM/+3MM OFFSET
|
Facility
|
IP
|
$2,194.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001996
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$877.60 |
| Max. Negotiated Rate |
$2,084.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,755.20
|
| Rate for Payer: Cash Price |
$1,316.40
|
| Rate for Payer: Cash Price |
$1,316.40
|
| Rate for Payer: Cigna Commercial |
$1,864.90
|
| Rate for Payer: First Health Commercial |
$1,974.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,974.60
|
| Rate for Payer: GEHA Commercial |
$1,535.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,974.60
|
| Rate for Payer: Multiplan All |
$1,996.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,535.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,974.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,084.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,645.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,040.42
|
| Rate for Payer: Zelis Auto |
$877.60
|
|
|
IMPLT HEAD FEMORAL 22.2MM/+3MM OFFSET
|
Facility
|
OP
|
$2,194.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001996
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$548.50 |
| Max. Negotiated Rate |
$2,084.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,316.40
|
| Rate for Payer: Cash Price |
$1,316.40
|
| Rate for Payer: Cash Price |
$1,316.40
|
| Rate for Payer: Cigna Commercial |
$1,864.90
|
| Rate for Payer: First Health Commercial |
$1,974.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,974.60
|
| Rate for Payer: GEHA Commercial |
$1,755.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,974.60
|
| Rate for Payer: Humana ChoiceCare |
$570.44
|
| Rate for Payer: Multiplan All |
$1,996.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,316.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,535.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,974.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,084.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,645.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,930.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$548.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,040.42
|
| Rate for Payer: Zelis Auto |
$877.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,097.00
|
|
|
IMPLT HEAD FEMORAL 22MM +0
|
Facility
|
IP
|
$3,151.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001997
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,260.40 |
| Max. Negotiated Rate |
$2,993.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,520.80
|
| Rate for Payer: Cash Price |
$1,890.60
|
| Rate for Payer: Cash Price |
$1,890.60
|
| Rate for Payer: Cigna Commercial |
$2,678.35
|
| Rate for Payer: First Health Commercial |
$2,835.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,835.90
|
| Rate for Payer: GEHA Commercial |
$2,205.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,835.90
|
| Rate for Payer: Multiplan All |
$2,867.41
|
| Rate for Payer: OMNI Networks Commercial |
$2,205.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,835.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,993.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,363.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,930.43
|
| Rate for Payer: Zelis Auto |
$1,260.40
|
|
|
IMPLT HEAD FEMORAL 22MM +0
|
Facility
|
OP
|
$3,151.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001997
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$787.75 |
| Max. Negotiated Rate |
$2,993.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,890.60
|
| Rate for Payer: Cash Price |
$1,890.60
|
| Rate for Payer: Cash Price |
$1,890.60
|
| Rate for Payer: Cigna Commercial |
$2,678.35
|
| Rate for Payer: First Health Commercial |
$2,835.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,835.90
|
| Rate for Payer: GEHA Commercial |
$2,520.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,835.90
|
| Rate for Payer: Humana ChoiceCare |
$819.26
|
| Rate for Payer: Multiplan All |
$2,867.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,890.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,205.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,835.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,993.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,363.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,772.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$787.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,930.43
|
| Rate for Payer: Zelis Auto |
$1,260.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,575.50
|
|
|
IMPLT HEAD FEMORAL 26X4MM
|
Facility
|
IP
|
$1,878.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002546
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$751.20 |
| Max. Negotiated Rate |
$1,784.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,502.40
|
| Rate for Payer: Cash Price |
$1,126.80
|
| Rate for Payer: Cash Price |
$1,126.80
|
| Rate for Payer: Cigna Commercial |
$1,596.30
|
| Rate for Payer: First Health Commercial |
$1,690.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,690.20
|
| Rate for Payer: GEHA Commercial |
$1,314.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,690.20
|
| Rate for Payer: Multiplan All |
$1,708.98
|
| Rate for Payer: OMNI Networks Commercial |
$1,314.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,690.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,784.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,408.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,746.54
|
| Rate for Payer: Zelis Auto |
$751.20
|
|
|
IMPLT HEAD FEMORAL 26X4MM
|
Facility
|
OP
|
$1,878.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002546
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$469.50 |
| Max. Negotiated Rate |
$1,784.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,126.80
|
| Rate for Payer: Cash Price |
$1,126.80
|
| Rate for Payer: Cash Price |
$1,126.80
|
| Rate for Payer: Cigna Commercial |
$1,596.30
|
| Rate for Payer: First Health Commercial |
$1,690.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,690.20
|
| Rate for Payer: GEHA Commercial |
$1,502.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,690.20
|
| Rate for Payer: Humana ChoiceCare |
$488.28
|
| Rate for Payer: Multiplan All |
$1,708.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,126.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,314.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,690.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,784.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,408.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,652.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$469.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,746.54
|
| Rate for Payer: Zelis Auto |
$751.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$939.00
|
|
|
IMPLT HEAD FEMORAL 28X4MM
|
Facility
|
OP
|
$1,878.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006453
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$469.50 |
| Max. Negotiated Rate |
$1,784.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,126.80
|
| Rate for Payer: Cash Price |
$1,126.80
|
| Rate for Payer: Cash Price |
$1,126.80
|
| Rate for Payer: Cigna Commercial |
$1,596.30
|
| Rate for Payer: First Health Commercial |
$1,690.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,690.20
|
| Rate for Payer: GEHA Commercial |
$1,502.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,690.20
|
| Rate for Payer: Humana ChoiceCare |
$488.28
|
| Rate for Payer: Multiplan All |
$1,708.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,126.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,314.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,690.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,784.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,408.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,652.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$469.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,746.54
|
| Rate for Payer: Zelis Auto |
$751.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$939.00
|
|
|
IMPLT HEAD FEMORAL 28X4MM
|
Facility
|
IP
|
$1,878.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006453
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$751.20 |
| Max. Negotiated Rate |
$1,784.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,502.40
|
| Rate for Payer: Cash Price |
$1,126.80
|
| Rate for Payer: Cash Price |
$1,126.80
|
| Rate for Payer: Cigna Commercial |
$1,596.30
|
| Rate for Payer: First Health Commercial |
$1,690.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,690.20
|
| Rate for Payer: GEHA Commercial |
$1,314.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,690.20
|
| Rate for Payer: Multiplan All |
$1,708.98
|
| Rate for Payer: OMNI Networks Commercial |
$1,314.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,690.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,784.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,408.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,746.54
|
| Rate for Payer: Zelis Auto |
$751.20
|
|
|
IMPLT HEAD FEMORAL 32MM +8MM OFFSET
|
Facility
|
IP
|
$2,194.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001998
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$877.60 |
| Max. Negotiated Rate |
$2,084.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,755.20
|
| Rate for Payer: Cash Price |
$1,316.40
|
| Rate for Payer: Cash Price |
$1,316.40
|
| Rate for Payer: Cigna Commercial |
$1,864.90
|
| Rate for Payer: First Health Commercial |
$1,974.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,974.60
|
| Rate for Payer: GEHA Commercial |
$1,535.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,974.60
|
| Rate for Payer: Multiplan All |
$1,996.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,535.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,974.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,084.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,645.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,040.42
|
| Rate for Payer: Zelis Auto |
$877.60
|
|
|
IMPLT HEAD FEMORAL 32MM +8MM OFFSET
|
Facility
|
OP
|
$2,194.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001998
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$548.50 |
| Max. Negotiated Rate |
$2,084.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,316.40
|
| Rate for Payer: Cash Price |
$1,316.40
|
| Rate for Payer: Cash Price |
$1,316.40
|
| Rate for Payer: Cigna Commercial |
$1,864.90
|
| Rate for Payer: First Health Commercial |
$1,974.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,974.60
|
| Rate for Payer: GEHA Commercial |
$1,755.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,974.60
|
| Rate for Payer: Humana ChoiceCare |
$570.44
|
| Rate for Payer: Multiplan All |
$1,996.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,316.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,535.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,974.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,084.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,645.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,930.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$548.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,040.42
|
| Rate for Payer: Zelis Auto |
$877.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,097.00
|
|
|
IMPLT HEAD FEMORAL 36MM +10MM OFFSET V40
|
Facility
|
IP
|
$2,194.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003315
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$877.60 |
| Max. Negotiated Rate |
$2,084.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,755.20
|
| Rate for Payer: Cash Price |
$1,316.40
|
| Rate for Payer: Cash Price |
$1,316.40
|
| Rate for Payer: Cigna Commercial |
$1,864.90
|
| Rate for Payer: First Health Commercial |
$1,974.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,974.60
|
| Rate for Payer: GEHA Commercial |
$1,535.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,974.60
|
| Rate for Payer: Multiplan All |
$1,996.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,535.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,974.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,084.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,645.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,040.42
|
| Rate for Payer: Zelis Auto |
$877.60
|
|
|
IMPLT HEAD FEMORAL 36MM +10MM OFFSET V40
|
Facility
|
OP
|
$2,194.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003315
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$548.50 |
| Max. Negotiated Rate |
$2,084.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,316.40
|
| Rate for Payer: Cash Price |
$1,316.40
|
| Rate for Payer: Cash Price |
$1,316.40
|
| Rate for Payer: Cigna Commercial |
$1,864.90
|
| Rate for Payer: First Health Commercial |
$1,974.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,974.60
|
| Rate for Payer: GEHA Commercial |
$1,755.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,974.60
|
| Rate for Payer: Humana ChoiceCare |
$570.44
|
| Rate for Payer: Multiplan All |
$1,996.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,316.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,535.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,974.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,084.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,645.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,930.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$548.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,040.42
|
| Rate for Payer: Zelis Auto |
$877.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,097.00
|
|
|
IMPLT HEAD FEMORAL ANATOMIC 40MM V40
|
Facility
|
OP
|
$3,806.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001851
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$951.50 |
| Max. Negotiated Rate |
$3,615.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,283.60
|
| Rate for Payer: Cash Price |
$2,283.60
|
| Rate for Payer: Cash Price |
$2,283.60
|
| Rate for Payer: Cigna Commercial |
$3,235.10
|
| Rate for Payer: First Health Commercial |
$3,425.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,425.40
|
| Rate for Payer: GEHA Commercial |
$3,044.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,425.40
|
| Rate for Payer: Humana ChoiceCare |
$989.56
|
| Rate for Payer: Multiplan All |
$3,463.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,283.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,664.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,425.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,615.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,854.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,349.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$951.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,539.58
|
| Rate for Payer: Zelis Auto |
$1,522.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,903.00
|
|
