|
IMPLT HEAD FEMORAL TAPER 28MM 12/14
|
Facility
|
IP
|
$3,197.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002030
|
|
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 36MM
|
Facility
|
OP
|
$5,542.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002009
|
|
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 TAPER 36MM
|
Facility
|
IP
|
$5,542.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002009
|
|
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 TAPER OXINIUM 32MM
|
Facility
|
IP
|
$5,542.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002010
|
|
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 TAPER OXINIUM 32MM
|
Facility
|
OP
|
$5,542.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002010
|
|
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 V40 22.2MM +0 OFFSET
|
Facility
|
OP
|
$2,194.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002022
|
|
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 V40 22.2MM +0 OFFSET
|
Facility
|
IP
|
$2,194.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002022
|
|
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 V40 OD22.2 OFFSET +8
|
Facility
|
OP
|
$2,194.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003077
|
|
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 V40 OD22.2 OFFSET +8
|
Facility
|
IP
|
$2,194.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003077
|
|
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 V40 OD26MM OFFSET-3MM
|
Facility
|
OP
|
$2,081.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$520.25 |
| Max. Negotiated Rate |
$1,976.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,248.60
|
| Rate for Payer: Cash Price |
$1,248.60
|
| Rate for Payer: Cash Price |
$1,248.60
|
| Rate for Payer: Cigna Commercial |
$1,768.85
|
| Rate for Payer: First Health Commercial |
$1,872.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,872.90
|
| Rate for Payer: GEHA Commercial |
$1,664.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,872.90
|
| Rate for Payer: Humana ChoiceCare |
$541.06
|
| Rate for Payer: Multiplan All |
$1,893.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,248.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,456.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,872.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,976.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,560.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,831.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$520.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,935.33
|
| Rate for Payer: Zelis Auto |
$832.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,040.50
|
|
|
IMPLT HEAD FEMORAL V40 OD26MM OFFSET-3MM
|
Facility
|
IP
|
$2,081.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$832.40 |
| Max. Negotiated Rate |
$1,976.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,664.80
|
| Rate for Payer: Cash Price |
$1,248.60
|
| Rate for Payer: Cash Price |
$1,248.60
|
| Rate for Payer: Cigna Commercial |
$1,768.85
|
| Rate for Payer: First Health Commercial |
$1,872.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,872.90
|
| Rate for Payer: GEHA Commercial |
$1,456.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,872.90
|
| Rate for Payer: Multiplan All |
$1,893.71
|
| Rate for Payer: OMNI Networks Commercial |
$1,456.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,872.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,976.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,560.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,935.33
|
| Rate for Payer: Zelis Auto |
$832.40
|
|
|
IMPLT HEAD FEMORAL V40 OD28MM OFFSET +12
|
Facility
|
OP
|
$2,194.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003047
|
|
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 V40 OD28MM OFFSET +12
|
Facility
|
IP
|
$2,194.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003047
|
|
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 V40 OD28MM OFFSET +8
|
Facility
|
IP
|
$2,194.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006176
|
|
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 V40 OD28MM OFFSET +8
|
Facility
|
OP
|
$2,194.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006176
|
|
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 V40 OFFSET +0MM
|
Facility
|
OP
|
$2,194.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002012
|
|
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 V40 OFFSET +0MM
|
Facility
|
IP
|
$2,194.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002012
|
|
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 HUMERAL 52 SIZE
|
Facility
|
OP
|
$9,830.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,457.50 |
| Max. Negotiated Rate |
$9,338.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,898.00
|
| Rate for Payer: Cash Price |
$5,898.00
|
| Rate for Payer: Cash Price |
$5,898.00
|
| Rate for Payer: Cigna Commercial |
$8,355.50
|
| Rate for Payer: First Health Commercial |
$8,847.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,847.00
|
| Rate for Payer: GEHA Commercial |
$7,864.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,847.00
|
| Rate for Payer: Humana ChoiceCare |
$2,555.80
|
| Rate for Payer: Multiplan All |
$8,945.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,898.00
|
| Rate for Payer: OMNI Networks Commercial |
$6,881.00
|
| Rate for Payer: One Health Plan PPO/POS |
$8,847.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9,338.50
|
| Rate for Payer: Three Rivers Provider Network All |
$7,372.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8,650.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,457.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9,141.90
|
| Rate for Payer: Zelis Auto |
$3,932.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,915.00
|
|
|
IMPLT HEAD HUMERAL 52 SIZE
|
Facility
|
IP
|
$9,830.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,932.00 |
| Max. Negotiated Rate |
$9,338.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7,864.00
|
| Rate for Payer: Cash Price |
$5,898.00
|
| Rate for Payer: Cash Price |
$5,898.00
|
| Rate for Payer: Cigna Commercial |
$8,355.50
|
| Rate for Payer: First Health Commercial |
$8,847.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,847.00
|
| Rate for Payer: GEHA Commercial |
$6,881.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,847.00
|
| Rate for Payer: Multiplan All |
$8,945.30
|
| Rate for Payer: OMNI Networks Commercial |
$6,881.00
|
| Rate for Payer: One Health Plan PPO/POS |
$8,847.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9,338.50
|
| Rate for Payer: Three Rivers Provider Network All |
$7,372.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9,141.90
|
| Rate for Payer: Zelis Auto |
$3,932.00
|
|
|
IMPLT HEAD HUMERAL COFIELD2 20X42MM
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001855
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$95.60 |
| Max. Negotiated Rate |
$227.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$191.20
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$203.15
|
| Rate for Payer: First Health Commercial |
$215.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$215.10
|
| Rate for Payer: GEHA Commercial |
$167.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$215.10
|
| Rate for Payer: Multiplan All |
$217.49
|
| Rate for Payer: OMNI Networks Commercial |
$167.30
|
| Rate for Payer: One Health Plan PPO/POS |
$215.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$227.05
|
| Rate for Payer: Three Rivers Provider Network All |
$179.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$222.27
|
| Rate for Payer: Zelis Auto |
$95.60
|
|
|
IMPLT HEAD HUMERAL COFIELD2 20X42MM
|
Facility
|
OP
|
$239.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001855
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$59.75 |
| Max. Negotiated Rate |
$227.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$143.40
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$203.15
|
| Rate for Payer: First Health Commercial |
$215.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$215.10
|
| Rate for Payer: GEHA Commercial |
$191.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$215.10
|
| Rate for Payer: Humana ChoiceCare |
$62.14
|
| Rate for Payer: Multiplan All |
$217.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$143.40
|
| Rate for Payer: OMNI Networks Commercial |
$167.30
|
| Rate for Payer: One Health Plan PPO/POS |
$215.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$227.05
|
| Rate for Payer: Three Rivers Provider Network All |
$179.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$210.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$59.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$222.27
|
| Rate for Payer: Zelis Auto |
$95.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$119.50
|
|
|
IMPLT HEAD HUMERAL ECCENTRIC 16X38MM
|
Facility
|
OP
|
$5,078.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001856
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,269.50 |
| Max. Negotiated Rate |
$4,824.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,046.80
|
| Rate for Payer: Cash Price |
$3,046.80
|
| Rate for Payer: Cash Price |
$3,046.80
|
| Rate for Payer: Cigna Commercial |
$4,316.30
|
| Rate for Payer: First Health Commercial |
$4,570.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,570.20
|
| Rate for Payer: GEHA Commercial |
$4,062.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,570.20
|
| Rate for Payer: Humana ChoiceCare |
$1,320.28
|
| Rate for Payer: Multiplan All |
$4,620.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,046.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,554.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,570.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,824.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,808.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,468.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,269.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,722.54
|
| Rate for Payer: Zelis Auto |
$2,031.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,539.00
|
|
|
IMPLT HEAD HUMERAL ECCENTRIC 16X38MM
|
Facility
|
IP
|
$5,078.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001856
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,031.20 |
| Max. Negotiated Rate |
$4,824.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,062.40
|
| Rate for Payer: Cash Price |
$3,046.80
|
| Rate for Payer: Cash Price |
$3,046.80
|
| Rate for Payer: Cigna Commercial |
$4,316.30
|
| Rate for Payer: First Health Commercial |
$4,570.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,570.20
|
| Rate for Payer: GEHA Commercial |
$3,554.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,570.20
|
| Rate for Payer: Multiplan All |
$4,620.98
|
| Rate for Payer: OMNI Networks Commercial |
$3,554.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,570.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,824.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,808.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,722.54
|
| Rate for Payer: Zelis Auto |
$2,031.20
|
|
|
IMPLT HEAD HUMERAL FROZEN 45MM
|
Facility
|
IP
|
$3,958.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,583.20 |
| Max. Negotiated Rate |
$3,760.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,166.40
|
| Rate for Payer: Cash Price |
$2,374.80
|
| Rate for Payer: Cash Price |
$2,374.80
|
| Rate for Payer: Cigna Commercial |
$3,364.30
|
| Rate for Payer: First Health Commercial |
$3,562.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,562.20
|
| Rate for Payer: GEHA Commercial |
$2,770.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,562.20
|
| Rate for Payer: Multiplan All |
$3,601.78
|
| Rate for Payer: OMNI Networks Commercial |
$2,770.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,562.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,760.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,968.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,680.94
|
| Rate for Payer: Zelis Auto |
$1,583.20
|
|
|
IMPLT HEAD HUMERAL FROZEN 45MM
|
Facility
|
OP
|
$3,958.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$989.50 |
| Max. Negotiated Rate |
$3,760.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,374.80
|
| Rate for Payer: Cash Price |
$2,374.80
|
| Rate for Payer: Cash Price |
$2,374.80
|
| Rate for Payer: Cigna Commercial |
$3,364.30
|
| Rate for Payer: First Health Commercial |
$3,562.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,562.20
|
| Rate for Payer: GEHA Commercial |
$3,166.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,562.20
|
| Rate for Payer: Humana ChoiceCare |
$1,029.08
|
| Rate for Payer: Multiplan All |
$3,601.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,374.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,770.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,562.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,760.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,968.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,483.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$989.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,680.94
|
| Rate for Payer: Zelis Auto |
$1,583.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,979.00
|
|
