|
IMPLT HEAD FEMORAL CEREMIC 32MM
|
Facility
|
IP
|
$3,502.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002005
|
|
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 CEREMIC 32MM
|
Facility
|
OP
|
$3,502.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002005
|
|
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 FROZEN
|
Facility
|
IP
|
$4,641.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002006
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,856.40 |
| Max. Negotiated Rate |
$4,408.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,712.80
|
| Rate for Payer: Cash Price |
$2,784.60
|
| Rate for Payer: Cash Price |
$2,784.60
|
| Rate for Payer: Cigna Commercial |
$3,944.85
|
| Rate for Payer: First Health Commercial |
$4,176.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,176.90
|
| Rate for Payer: GEHA Commercial |
$3,248.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,176.90
|
| Rate for Payer: Multiplan All |
$4,223.31
|
| Rate for Payer: OMNI Networks Commercial |
$3,248.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,176.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,408.95
|
| Rate for Payer: Three Rivers Provider Network All |
$3,480.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,316.13
|
| Rate for Payer: Zelis Auto |
$1,856.40
|
|
|
IMPLT HEAD FEMORAL FROZEN
|
Facility
|
OP
|
$4,641.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002006
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,160.25 |
| Max. Negotiated Rate |
$4,408.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,784.60
|
| Rate for Payer: Cash Price |
$2,784.60
|
| Rate for Payer: Cash Price |
$2,784.60
|
| Rate for Payer: Cigna Commercial |
$3,944.85
|
| Rate for Payer: First Health Commercial |
$4,176.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,176.90
|
| Rate for Payer: GEHA Commercial |
$3,712.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,176.90
|
| Rate for Payer: Humana ChoiceCare |
$1,206.66
|
| Rate for Payer: Multiplan All |
$4,223.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,784.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,248.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,176.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,408.95
|
| Rate for Payer: Three Rivers Provider Network All |
$3,480.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,084.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,160.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,316.13
|
| Rate for Payer: Zelis Auto |
$1,856.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,320.50
|
|
|
IMPLT HEAD FEMORAL LFIT 32MM +0MM
|
Facility
|
OP
|
$2,702.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$675.50 |
| Max. Negotiated Rate |
$2,566.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,621.20
|
| Rate for Payer: Cash Price |
$1,621.20
|
| Rate for Payer: Cash Price |
$1,621.20
|
| Rate for Payer: Cigna Commercial |
$2,296.70
|
| Rate for Payer: First Health Commercial |
$2,431.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,431.80
|
| Rate for Payer: GEHA Commercial |
$2,161.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,431.80
|
| Rate for Payer: Humana ChoiceCare |
$702.52
|
| Rate for Payer: Multiplan All |
$2,458.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,621.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,891.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,431.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,566.90
|
| Rate for Payer: Three Rivers Provider Network All |
$2,026.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,377.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$675.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,512.86
|
| Rate for Payer: Zelis Auto |
$1,080.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,351.00
|
|
|
IMPLT HEAD FEMORAL LFIT 32MM +0MM
|
Facility
|
IP
|
$2,702.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,080.80 |
| Max. Negotiated Rate |
$2,566.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,161.60
|
| Rate for Payer: Cash Price |
$1,621.20
|
| Rate for Payer: Cash Price |
$1,621.20
|
| Rate for Payer: Cigna Commercial |
$2,296.70
|
| Rate for Payer: First Health Commercial |
$2,431.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,431.80
|
| Rate for Payer: GEHA Commercial |
$1,891.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,431.80
|
| Rate for Payer: Multiplan All |
$2,458.82
|
| Rate for Payer: OMNI Networks Commercial |
$1,891.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,431.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,566.90
|
| Rate for Payer: Three Rivers Provider Network All |
$2,026.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,512.86
|
| Rate for Payer: Zelis Auto |
$1,080.80
|
|
|
IMPLT HEAD FEMORAL LFIT V40 22.2MM +0MM
|
Facility
|
OP
|
$2,194.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7007045
|
|
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 LFIT V40 22.2MM +0MM
|
Facility
|
IP
|
$2,194.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7007045
|
|
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 LFIT V40 26MM +0MM
|
Facility
|
IP
|
$2,194.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002008
|
|
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 LFIT V40 26MM +0MM
|
Facility
|
OP
|
$2,194.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002008
|
|
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 MODULAR 40MM
|
Facility
|
IP
|
$5,542.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002027
|
|
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 MODULAR 40MM
|
Facility
|
OP
|
$5,542.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002027
|
|
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 OFFSET SIZE 36MM
|
Facility
|
OP
|
$2,194.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002024
|
|
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 OFFSET SIZE 36MM
|
Facility
|
IP
|
$2,194.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002024
|
|
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 OXINIUM 12/14
|
Facility
|
OP
|
$5,542.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001852
|
|
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 OXINIUM 12/14
|
Facility
|
IP
|
$5,542.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001852
|
|
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 OXINIUM 36MM
|
Facility
|
IP
|
$5,542.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002028
|
|
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 OXINIUM 36MM
|
Facility
|
OP
|
$5,542.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002028
|
|
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 SIZE 36MM
|
Facility
|
OP
|
$2,194.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002025
|
|
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 SIZE 36MM
|
Facility
|
IP
|
$2,194.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002025
|
|
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 SIZE 36MM
|
Facility
|
IP
|
$2,217.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006590
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$886.80 |
| Max. Negotiated Rate |
$2,106.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,773.60
|
| Rate for Payer: Cash Price |
$1,330.20
|
| Rate for Payer: Cash Price |
$1,330.20
|
| Rate for Payer: Cigna Commercial |
$1,884.45
|
| Rate for Payer: First Health Commercial |
$1,995.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,995.30
|
| Rate for Payer: GEHA Commercial |
$1,551.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,995.30
|
| Rate for Payer: Multiplan All |
$2,017.47
|
| Rate for Payer: OMNI Networks Commercial |
$1,551.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,995.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,106.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,662.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,061.81
|
| Rate for Payer: Zelis Auto |
$886.80
|
|
|
IMPLT HEAD FEMORAL SIZE 36MM
|
Facility
|
OP
|
$2,217.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006590
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$554.25 |
| Max. Negotiated Rate |
$2,106.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,330.20
|
| Rate for Payer: Cash Price |
$1,330.20
|
| Rate for Payer: Cash Price |
$1,330.20
|
| Rate for Payer: Cigna Commercial |
$1,884.45
|
| Rate for Payer: First Health Commercial |
$1,995.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,995.30
|
| Rate for Payer: GEHA Commercial |
$1,773.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,995.30
|
| Rate for Payer: Humana ChoiceCare |
$576.42
|
| Rate for Payer: Multiplan All |
$2,017.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,330.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,551.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,995.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,106.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,662.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,950.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$554.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,061.81
|
| Rate for Payer: Zelis Auto |
$886.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,108.50
|
|
|
IMPLT HEAD FEMORAL TAPER 12/14 28OD
|
Facility
|
OP
|
$3,197.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002029
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$799.25 |
| Max. Negotiated Rate |
$3,037.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,918.20
|
| Rate for Payer: Cash Price |
$1,918.20
|
| Rate for Payer: Cash Price |
$1,918.20
|
| Rate for Payer: Cigna Commercial |
$2,717.45
|
| Rate for Payer: First Health Commercial |
$2,877.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,877.30
|
| Rate for Payer: GEHA Commercial |
$2,557.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,877.30
|
| Rate for Payer: Humana ChoiceCare |
$831.22
|
| Rate for Payer: Multiplan All |
$2,909.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,918.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,237.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,877.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,037.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,397.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,813.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$799.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,973.21
|
| Rate for Payer: Zelis Auto |
$1,278.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,598.50
|
|
|
IMPLT HEAD FEMORAL TAPER 12/14 28OD
|
Facility
|
IP
|
$3,197.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002029
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,278.80 |
| Max. Negotiated Rate |
$3,037.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,557.60
|
| Rate for Payer: Cash Price |
$1,918.20
|
| Rate for Payer: Cash Price |
$1,918.20
|
| Rate for Payer: Cigna Commercial |
$2,717.45
|
| Rate for Payer: First Health Commercial |
$2,877.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,877.30
|
| Rate for Payer: GEHA Commercial |
$2,237.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,877.30
|
| Rate for Payer: Multiplan All |
$2,909.27
|
| Rate for Payer: OMNI Networks Commercial |
$2,237.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,877.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,037.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,397.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,973.21
|
| Rate for Payer: Zelis Auto |
$1,278.80
|
|
|
IMPLT HEAD FEMORAL TAPER 28MM 12/14
|
Facility
|
OP
|
$3,197.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$799.25 |
| Max. Negotiated Rate |
$3,037.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,918.20
|
| Rate for Payer: Cash Price |
$1,918.20
|
| Rate for Payer: Cash Price |
$1,918.20
|
| Rate for Payer: Cigna Commercial |
$2,717.45
|
| Rate for Payer: First Health Commercial |
$2,877.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,877.30
|
| Rate for Payer: GEHA Commercial |
$2,557.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,877.30
|
| Rate for Payer: Humana ChoiceCare |
$831.22
|
| Rate for Payer: Multiplan All |
$2,909.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,918.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,237.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,877.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,037.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,397.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,813.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$799.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,973.21
|
| Rate for Payer: Zelis Auto |
$1,278.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,598.50
|
|
