|
IMPLT HEAD FEMORAL ANATOMIC 40MM V40
|
Facility
|
IP
|
$3,806.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001851
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,522.40 |
| Max. Negotiated Rate |
$3,615.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,044.80
|
| 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 |
$2,664.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,425.40
|
| Rate for Payer: Multiplan All |
$3,463.46
|
| 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: United Payors & United Providers UP&UP |
$3,539.58
|
| Rate for Payer: Zelis Auto |
$1,522.40
|
|
|
IMPLT HEAD FEMORAL CERAMIC 11/13 TAPER
|
Facility
|
IP
|
$6,291.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002576
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,516.40 |
| Max. Negotiated Rate |
$5,976.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,032.80
|
| Rate for Payer: Cash Price |
$3,774.60
|
| Rate for Payer: Cash Price |
$3,774.60
|
| Rate for Payer: Cigna Commercial |
$5,347.35
|
| Rate for Payer: First Health Commercial |
$5,661.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,661.90
|
| Rate for Payer: GEHA Commercial |
$4,403.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,661.90
|
| Rate for Payer: Multiplan All |
$5,724.81
|
| Rate for Payer: OMNI Networks Commercial |
$4,403.70
|
| Rate for Payer: One Health Plan PPO/POS |
$5,661.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,976.45
|
| Rate for Payer: Three Rivers Provider Network All |
$4,718.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,850.63
|
| Rate for Payer: Zelis Auto |
$2,516.40
|
|
|
IMPLT HEAD FEMORAL CERAMIC 11/13 TAPER
|
Facility
|
OP
|
$6,291.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002576
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,572.75 |
| Max. Negotiated Rate |
$5,976.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,774.60
|
| Rate for Payer: Cash Price |
$3,774.60
|
| Rate for Payer: Cash Price |
$3,774.60
|
| Rate for Payer: Cigna Commercial |
$5,347.35
|
| Rate for Payer: First Health Commercial |
$5,661.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,661.90
|
| Rate for Payer: GEHA Commercial |
$5,032.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,661.90
|
| Rate for Payer: Humana ChoiceCare |
$1,635.66
|
| Rate for Payer: Multiplan All |
$5,724.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,774.60
|
| Rate for Payer: OMNI Networks Commercial |
$4,403.70
|
| Rate for Payer: One Health Plan PPO/POS |
$5,661.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,976.45
|
| Rate for Payer: Three Rivers Provider Network All |
$4,718.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,536.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,572.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,850.63
|
| Rate for Payer: Zelis Auto |
$2,516.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,145.50
|
|
|
IMPLT HEAD FEMORAL CERAMIC 12/14 TAPER
|
Facility
|
OP
|
$2,987.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006425
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$746.75 |
| Max. Negotiated Rate |
$2,837.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,792.20
|
| Rate for Payer: Cash Price |
$1,792.20
|
| Rate for Payer: Cash Price |
$1,792.20
|
| Rate for Payer: Cigna Commercial |
$2,538.95
|
| Rate for Payer: First Health Commercial |
$2,688.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,688.30
|
| Rate for Payer: GEHA Commercial |
$2,389.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,688.30
|
| Rate for Payer: Humana ChoiceCare |
$776.62
|
| Rate for Payer: Multiplan All |
$2,718.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,792.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,090.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,688.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,837.65
|
| Rate for Payer: Three Rivers Provider Network All |
$2,240.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,628.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$746.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,777.91
|
| Rate for Payer: Zelis Auto |
$1,194.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,493.50
|
|
|
IMPLT HEAD FEMORAL CERAMIC 12/14 TAPER
|
Facility
|
IP
|
$2,987.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006425
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,194.80 |
| Max. Negotiated Rate |
$2,837.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,389.60
|
| Rate for Payer: Cash Price |
$1,792.20
|
| Rate for Payer: Cash Price |
$1,792.20
|
| Rate for Payer: Cigna Commercial |
$2,538.95
|
| Rate for Payer: First Health Commercial |
$2,688.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,688.30
|
| Rate for Payer: GEHA Commercial |
$2,090.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,688.30
|
| Rate for Payer: Multiplan All |
$2,718.17
|
| Rate for Payer: OMNI Networks Commercial |
$2,090.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,688.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,837.65
|
| Rate for Payer: Three Rivers Provider Network All |
$2,240.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,777.91
|
| Rate for Payer: Zelis Auto |
$1,194.80
|
|
|
IMPLT HEAD FEMORAL CERAMIC 28X-2.7MM
|
Facility
|
IP
|
$2,588.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002584
|
|
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 FEMORAL CERAMIC 28X-2.7MM
|
Facility
|
OP
|
$2,588.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002584
|
|
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 FEMORAL CERAMIC 32MM
|
Facility
|
IP
|
$2,588.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001999
|
|
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 FEMORAL CERAMIC 32MM
|
Facility
|
OP
|
$2,588.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001999
|
|
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 FEMORAL CERAMIC 36MM
|
Facility
|
OP
|
$2,588.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006387
|
|
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 FEMORAL CERAMIC 36MM
|
Facility
|
IP
|
$2,588.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006387
|
|
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 FEMORAL CERAMIC 36MM
|
Facility
|
IP
|
$2,588.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002000
|
|
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 FEMORAL CERAMIC 36MM
|
Facility
|
OP
|
$2,588.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002000
|
|
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 FEMORAL CERAMIC BIOLOX 36MM
|
Facility
|
IP
|
$3,502.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,400.80 |
| Max. Negotiated Rate |
$3,326.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,801.60
|
| Rate for Payer: Cash Price |
$2,101.20
|
| Rate for Payer: Cash Price |
$2,101.20
|
| Rate for Payer: Cigna Commercial |
$2,976.70
|
| Rate for Payer: First Health Commercial |
$3,151.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,151.80
|
| Rate for Payer: GEHA Commercial |
$2,451.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,151.80
|
| Rate for Payer: Multiplan All |
$3,186.82
|
| Rate for Payer: OMNI Networks Commercial |
$2,451.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,151.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,326.90
|
| Rate for Payer: Three Rivers Provider Network All |
$2,626.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,256.86
|
| Rate for Payer: Zelis Auto |
$1,400.80
|
|
|
IMPLT HEAD FEMORAL CERAMIC BIOLOX 36MM
|
Facility
|
OP
|
$3,502.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$875.50 |
| Max. Negotiated Rate |
$3,326.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,101.20
|
| Rate for Payer: Cash Price |
$2,101.20
|
| Rate for Payer: Cash Price |
$2,101.20
|
| Rate for Payer: Cigna Commercial |
$2,976.70
|
| Rate for Payer: First Health Commercial |
$3,151.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,151.80
|
| Rate for Payer: GEHA Commercial |
$2,801.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,151.80
|
| Rate for Payer: Humana ChoiceCare |
$910.52
|
| Rate for Payer: Multiplan All |
$3,186.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,101.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,451.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,151.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,326.90
|
| Rate for Payer: Three Rivers Provider Network All |
$2,626.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,081.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$875.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,256.86
|
| Rate for Payer: Zelis Auto |
$1,400.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,751.00
|
|
|
IMPLT HEAD FEMORAL CERAMIC OD28 NECK+0MM
|
Facility
|
OP
|
$2,588.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002002
|
|
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 FEMORAL CERAMIC OD28 NECK+0MM
|
Facility
|
IP
|
$2,588.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002002
|
|
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 FEMORAL CERAMIC OD36MM
|
Facility
|
OP
|
$2,588.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002023
|
|
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 FEMORAL CERAMIC OD36MM
|
Facility
|
IP
|
$2,588.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002023
|
|
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 FEMORAL CERAMIC V40
|
Facility
|
OP
|
$2,588.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002004
|
|
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 FEMORAL CERAMIC V40
|
Facility
|
IP
|
$2,588.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002003
|
|
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 FEMORAL CERAMIC V40
|
Facility
|
OP
|
$2,588.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002003
|
|
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 FEMORAL CERAMIC V40
|
Facility
|
IP
|
$2,588.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002004
|
|
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 FEMORAL CERAMIC V40 36MM
|
Facility
|
IP
|
$2,588.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001785
|
|
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 FEMORAL CERAMIC V40 36MM
|
Facility
|
OP
|
$2,588.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001785
|
|
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
|
|
