|
IMPLT HEAD HUMERAL RADIUS SINGLE
|
Facility
|
OP
|
$10,676.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,669.00 |
| Max. Negotiated Rate |
$10,142.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,405.60
|
| Rate for Payer: Cash Price |
$6,405.60
|
| Rate for Payer: Cash Price |
$6,405.60
|
| Rate for Payer: Cigna Commercial |
$9,074.60
|
| Rate for Payer: First Health Commercial |
$9,608.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9,608.40
|
| Rate for Payer: GEHA Commercial |
$8,540.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9,608.40
|
| Rate for Payer: Humana ChoiceCare |
$2,775.76
|
| Rate for Payer: Multiplan All |
$9,715.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6,405.60
|
| Rate for Payer: OMNI Networks Commercial |
$7,473.20
|
| Rate for Payer: One Health Plan PPO/POS |
$9,608.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10,142.20
|
| Rate for Payer: Three Rivers Provider Network All |
$8,007.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9,394.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,669.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9,928.68
|
| Rate for Payer: Zelis Auto |
$4,270.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,338.00
|
|
|
IMPLT HEAD HUMERAL RADIUS SINGLE
|
Facility
|
IP
|
$10,676.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,270.40 |
| Max. Negotiated Rate |
$10,142.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$8,540.80
|
| Rate for Payer: Cash Price |
$6,405.60
|
| Rate for Payer: Cash Price |
$6,405.60
|
| Rate for Payer: Cigna Commercial |
$9,074.60
|
| Rate for Payer: First Health Commercial |
$9,608.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9,608.40
|
| Rate for Payer: GEHA Commercial |
$7,473.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9,608.40
|
| Rate for Payer: Multiplan All |
$9,715.16
|
| Rate for Payer: OMNI Networks Commercial |
$7,473.20
|
| Rate for Payer: One Health Plan PPO/POS |
$9,608.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10,142.20
|
| Rate for Payer: Three Rivers Provider Network All |
$8,007.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9,928.68
|
| Rate for Payer: Zelis Auto |
$4,270.40
|
|
|
IMPLT HEAD HUMERAL RADIUS SINGLE 52 SZ
|
Facility
|
OP
|
$10,204.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002498
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,551.00 |
| Max. Negotiated Rate |
$9,693.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,122.40
|
| Rate for Payer: Cash Price |
$6,122.40
|
| Rate for Payer: Cash Price |
$6,122.40
|
| Rate for Payer: Cigna Commercial |
$8,673.40
|
| Rate for Payer: First Health Commercial |
$9,183.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9,183.60
|
| Rate for Payer: GEHA Commercial |
$8,163.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9,183.60
|
| Rate for Payer: Humana ChoiceCare |
$2,653.04
|
| Rate for Payer: Multiplan All |
$9,285.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6,122.40
|
| Rate for Payer: OMNI Networks Commercial |
$7,142.80
|
| Rate for Payer: One Health Plan PPO/POS |
$9,183.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9,693.80
|
| Rate for Payer: Three Rivers Provider Network All |
$7,653.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8,979.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,551.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9,489.72
|
| Rate for Payer: Zelis Auto |
$4,081.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,102.00
|
|
|
IMPLT HEAD HUMERAL RADIUS SINGLE 52 SZ
|
Facility
|
IP
|
$10,204.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002498
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,081.60 |
| Max. Negotiated Rate |
$9,693.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$8,163.20
|
| Rate for Payer: Cash Price |
$6,122.40
|
| Rate for Payer: Cash Price |
$6,122.40
|
| Rate for Payer: Cigna Commercial |
$8,673.40
|
| Rate for Payer: First Health Commercial |
$9,183.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9,183.60
|
| Rate for Payer: GEHA Commercial |
$7,142.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9,183.60
|
| Rate for Payer: Multiplan All |
$9,285.64
|
| Rate for Payer: OMNI Networks Commercial |
$7,142.80
|
| Rate for Payer: One Health Plan PPO/POS |
$9,183.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9,693.80
|
| Rate for Payer: Three Rivers Provider Network All |
$7,653.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9,489.72
|
| Rate for Payer: Zelis Auto |
$4,081.60
|
|
|
IMPLT HEAD HUMERAL RADIUS SINGLE SIZE 48
|
Facility
|
IP
|
$10,338.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,135.20 |
| Max. Negotiated Rate |
$9,821.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$8,270.40
|
| Rate for Payer: Cash Price |
$6,202.80
|
| Rate for Payer: Cash Price |
$6,202.80
|
| Rate for Payer: Cigna Commercial |
$8,787.30
|
| Rate for Payer: First Health Commercial |
$9,304.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9,304.20
|
| Rate for Payer: GEHA Commercial |
$7,236.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9,304.20
|
| Rate for Payer: Multiplan All |
$9,407.58
|
| Rate for Payer: OMNI Networks Commercial |
$7,236.60
|
| Rate for Payer: One Health Plan PPO/POS |
$9,304.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9,821.10
|
| Rate for Payer: Three Rivers Provider Network All |
$7,753.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9,614.34
|
| Rate for Payer: Zelis Auto |
$4,135.20
|
|
|
IMPLT HEAD HUMERAL RADIUS SINGLE SIZE 48
|
Facility
|
OP
|
$10,338.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,584.50 |
| Max. Negotiated Rate |
$9,821.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,202.80
|
| Rate for Payer: Cash Price |
$6,202.80
|
| Rate for Payer: Cash Price |
$6,202.80
|
| Rate for Payer: Cigna Commercial |
$8,787.30
|
| Rate for Payer: First Health Commercial |
$9,304.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9,304.20
|
| Rate for Payer: GEHA Commercial |
$8,270.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9,304.20
|
| Rate for Payer: Humana ChoiceCare |
$2,687.88
|
| Rate for Payer: Multiplan All |
$9,407.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6,202.80
|
| Rate for Payer: OMNI Networks Commercial |
$7,236.60
|
| Rate for Payer: One Health Plan PPO/POS |
$9,304.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9,821.10
|
| Rate for Payer: Three Rivers Provider Network All |
$7,753.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9,097.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,584.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9,614.34
|
| Rate for Payer: Zelis Auto |
$4,135.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,169.00
|
|
|
IMPLT HEAD HUMERAL RADIUS SINGLE SIZE 56
|
Facility
|
IP
|
$11,117.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,446.80 |
| Max. Negotiated Rate |
$10,561.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$8,893.60
|
| Rate for Payer: Cash Price |
$6,670.20
|
| Rate for Payer: Cash Price |
$6,670.20
|
| Rate for Payer: Cigna Commercial |
$9,449.45
|
| Rate for Payer: First Health Commercial |
$10,005.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10,005.30
|
| Rate for Payer: GEHA Commercial |
$7,781.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10,005.30
|
| Rate for Payer: Multiplan All |
$10,116.47
|
| Rate for Payer: OMNI Networks Commercial |
$7,781.90
|
| Rate for Payer: One Health Plan PPO/POS |
$10,005.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10,561.15
|
| Rate for Payer: Three Rivers Provider Network All |
$8,337.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$10,338.81
|
| Rate for Payer: Zelis Auto |
$4,446.80
|
|
|
IMPLT HEAD HUMERAL RADIUS SINGLE SIZE 56
|
Facility
|
OP
|
$11,117.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,779.25 |
| Max. Negotiated Rate |
$10,561.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,670.20
|
| Rate for Payer: Cash Price |
$6,670.20
|
| Rate for Payer: Cash Price |
$6,670.20
|
| Rate for Payer: Cigna Commercial |
$9,449.45
|
| Rate for Payer: First Health Commercial |
$10,005.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10,005.30
|
| Rate for Payer: GEHA Commercial |
$8,893.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10,005.30
|
| Rate for Payer: Humana ChoiceCare |
$2,890.42
|
| Rate for Payer: Multiplan All |
$10,116.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6,670.20
|
| Rate for Payer: OMNI Networks Commercial |
$7,781.90
|
| Rate for Payer: One Health Plan PPO/POS |
$10,005.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10,561.15
|
| Rate for Payer: Three Rivers Provider Network All |
$8,337.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9,782.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,779.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$10,338.81
|
| Rate for Payer: Zelis Auto |
$4,446.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,558.50
|
|
|
IMPLT HEAD HUMERAL RAD SINGLE SZ 48X18MM
|
Facility
|
IP
|
$6,388.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,555.20 |
| Max. Negotiated Rate |
$6,068.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,110.40
|
| Rate for Payer: Cash Price |
$3,832.80
|
| Rate for Payer: Cash Price |
$3,832.80
|
| Rate for Payer: Cigna Commercial |
$5,429.80
|
| Rate for Payer: First Health Commercial |
$5,749.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,749.20
|
| Rate for Payer: GEHA Commercial |
$4,471.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,749.20
|
| Rate for Payer: Multiplan All |
$5,813.08
|
| Rate for Payer: OMNI Networks Commercial |
$4,471.60
|
| Rate for Payer: One Health Plan PPO/POS |
$5,749.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,068.60
|
| Rate for Payer: Three Rivers Provider Network All |
$4,791.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,940.84
|
| Rate for Payer: Zelis Auto |
$2,555.20
|
|
|
IMPLT HEAD HUMERAL RAD SINGLE SZ 48X18MM
|
Facility
|
OP
|
$6,388.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,597.00 |
| Max. Negotiated Rate |
$6,068.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,832.80
|
| Rate for Payer: Cash Price |
$3,832.80
|
| Rate for Payer: Cash Price |
$3,832.80
|
| Rate for Payer: Cigna Commercial |
$5,429.80
|
| Rate for Payer: First Health Commercial |
$5,749.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,749.20
|
| Rate for Payer: GEHA Commercial |
$5,110.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,749.20
|
| Rate for Payer: Humana ChoiceCare |
$1,660.88
|
| Rate for Payer: Multiplan All |
$5,813.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,832.80
|
| Rate for Payer: OMNI Networks Commercial |
$4,471.60
|
| Rate for Payer: One Health Plan PPO/POS |
$5,749.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,068.60
|
| Rate for Payer: Three Rivers Provider Network All |
$4,791.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,621.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,597.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,940.84
|
| Rate for Payer: Zelis Auto |
$2,555.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,194.00
|
|
|
IMPLT HEAD HUMERAL RAD SINGLE SZ 48X21MM
|
Facility
|
OP
|
$6,388.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006650
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,597.00 |
| Max. Negotiated Rate |
$6,068.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,832.80
|
| Rate for Payer: Cash Price |
$3,832.80
|
| Rate for Payer: Cash Price |
$3,832.80
|
| Rate for Payer: Cigna Commercial |
$5,429.80
|
| Rate for Payer: First Health Commercial |
$5,749.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,749.20
|
| Rate for Payer: GEHA Commercial |
$5,110.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,749.20
|
| Rate for Payer: Humana ChoiceCare |
$1,660.88
|
| Rate for Payer: Multiplan All |
$5,813.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,832.80
|
| Rate for Payer: OMNI Networks Commercial |
$4,471.60
|
| Rate for Payer: One Health Plan PPO/POS |
$5,749.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,068.60
|
| Rate for Payer: Three Rivers Provider Network All |
$4,791.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,621.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,597.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,940.84
|
| Rate for Payer: Zelis Auto |
$2,555.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,194.00
|
|
|
IMPLT HEAD HUMERAL RAD SINGLE SZ 48X21MM
|
Facility
|
IP
|
$6,388.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006650
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,555.20 |
| Max. Negotiated Rate |
$6,068.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,110.40
|
| Rate for Payer: Cash Price |
$3,832.80
|
| Rate for Payer: Cash Price |
$3,832.80
|
| Rate for Payer: Cigna Commercial |
$5,429.80
|
| Rate for Payer: First Health Commercial |
$5,749.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,749.20
|
| Rate for Payer: GEHA Commercial |
$4,471.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,749.20
|
| Rate for Payer: Multiplan All |
$5,813.08
|
| Rate for Payer: OMNI Networks Commercial |
$4,471.60
|
| Rate for Payer: One Health Plan PPO/POS |
$5,749.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,068.60
|
| Rate for Payer: Three Rivers Provider Network All |
$4,791.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,940.84
|
| Rate for Payer: Zelis Auto |
$2,555.20
|
|
|
IMPLT HEAD HUMERAL RAD SINGLE SZ 48X24MM
|
Facility
|
OP
|
$6,540.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003024
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,635.00 |
| Max. Negotiated Rate |
$6,213.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,924.00
|
| Rate for Payer: Cash Price |
$3,924.00
|
| Rate for Payer: Cash Price |
$3,924.00
|
| Rate for Payer: Cigna Commercial |
$5,559.00
|
| Rate for Payer: First Health Commercial |
$5,886.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,886.00
|
| Rate for Payer: GEHA Commercial |
$5,232.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,886.00
|
| Rate for Payer: Humana ChoiceCare |
$1,700.40
|
| Rate for Payer: Multiplan All |
$5,951.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,924.00
|
| Rate for Payer: OMNI Networks Commercial |
$4,578.00
|
| Rate for Payer: One Health Plan PPO/POS |
$5,886.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,213.00
|
| Rate for Payer: Three Rivers Provider Network All |
$4,905.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,755.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,635.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,082.20
|
| Rate for Payer: Zelis Auto |
$2,616.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,270.00
|
|
|
IMPLT HEAD HUMERAL RAD SINGLE SZ 48X24MM
|
Facility
|
IP
|
$6,540.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003024
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,616.00 |
| Max. Negotiated Rate |
$6,213.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,232.00
|
| Rate for Payer: Cash Price |
$3,924.00
|
| Rate for Payer: Cash Price |
$3,924.00
|
| Rate for Payer: Cigna Commercial |
$5,559.00
|
| Rate for Payer: First Health Commercial |
$5,886.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,886.00
|
| Rate for Payer: GEHA Commercial |
$4,578.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,886.00
|
| Rate for Payer: Multiplan All |
$5,951.40
|
| Rate for Payer: OMNI Networks Commercial |
$4,578.00
|
| Rate for Payer: One Health Plan PPO/POS |
$5,886.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,213.00
|
| Rate for Payer: Three Rivers Provider Network All |
$4,905.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,082.20
|
| Rate for Payer: Zelis Auto |
$2,616.00
|
|
|
IMPLT HEAD HUMERAL SIZE 40 14MM
|
Facility
|
IP
|
$6,388.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002994
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,555.20 |
| Max. Negotiated Rate |
$6,068.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,110.40
|
| Rate for Payer: Cash Price |
$3,832.80
|
| Rate for Payer: Cash Price |
$3,832.80
|
| Rate for Payer: Cigna Commercial |
$5,429.80
|
| Rate for Payer: First Health Commercial |
$5,749.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,749.20
|
| Rate for Payer: GEHA Commercial |
$4,471.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,749.20
|
| Rate for Payer: Multiplan All |
$5,813.08
|
| Rate for Payer: OMNI Networks Commercial |
$4,471.60
|
| Rate for Payer: One Health Plan PPO/POS |
$5,749.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,068.60
|
| Rate for Payer: Three Rivers Provider Network All |
$4,791.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,940.84
|
| Rate for Payer: Zelis Auto |
$2,555.20
|
|
|
IMPLT HEAD HUMERAL SIZE 40 14MM
|
Facility
|
OP
|
$6,388.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002994
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,597.00 |
| Max. Negotiated Rate |
$6,068.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,832.80
|
| Rate for Payer: Cash Price |
$3,832.80
|
| Rate for Payer: Cash Price |
$3,832.80
|
| Rate for Payer: Cigna Commercial |
$5,429.80
|
| Rate for Payer: First Health Commercial |
$5,749.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,749.20
|
| Rate for Payer: GEHA Commercial |
$5,110.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,749.20
|
| Rate for Payer: Humana ChoiceCare |
$1,660.88
|
| Rate for Payer: Multiplan All |
$5,813.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,832.80
|
| Rate for Payer: OMNI Networks Commercial |
$4,471.60
|
| Rate for Payer: One Health Plan PPO/POS |
$5,749.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,068.60
|
| Rate for Payer: Three Rivers Provider Network All |
$4,791.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,621.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,597.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,940.84
|
| Rate for Payer: Zelis Auto |
$2,555.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,194.00
|
|
|
IMPLT HEAD HUMERAL SIZE44 16MM
|
Facility
|
IP
|
$6,388.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003153
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,555.20 |
| Max. Negotiated Rate |
$6,068.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,110.40
|
| Rate for Payer: Cash Price |
$3,832.80
|
| Rate for Payer: Cash Price |
$3,832.80
|
| Rate for Payer: Cigna Commercial |
$5,429.80
|
| Rate for Payer: First Health Commercial |
$5,749.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,749.20
|
| Rate for Payer: GEHA Commercial |
$4,471.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,749.20
|
| Rate for Payer: Multiplan All |
$5,813.08
|
| Rate for Payer: OMNI Networks Commercial |
$4,471.60
|
| Rate for Payer: One Health Plan PPO/POS |
$5,749.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,068.60
|
| Rate for Payer: Three Rivers Provider Network All |
$4,791.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,940.84
|
| Rate for Payer: Zelis Auto |
$2,555.20
|
|
|
IMPLT HEAD HUMERAL SIZE44 16MM
|
Facility
|
OP
|
$6,388.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003153
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,597.00 |
| Max. Negotiated Rate |
$6,068.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,832.80
|
| Rate for Payer: Cash Price |
$3,832.80
|
| Rate for Payer: Cash Price |
$3,832.80
|
| Rate for Payer: Cigna Commercial |
$5,429.80
|
| Rate for Payer: First Health Commercial |
$5,749.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,749.20
|
| Rate for Payer: GEHA Commercial |
$5,110.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,749.20
|
| Rate for Payer: Humana ChoiceCare |
$1,660.88
|
| Rate for Payer: Multiplan All |
$5,813.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,832.80
|
| Rate for Payer: OMNI Networks Commercial |
$4,471.60
|
| Rate for Payer: One Health Plan PPO/POS |
$5,749.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,068.60
|
| Rate for Payer: Three Rivers Provider Network All |
$4,791.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,621.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,597.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,940.84
|
| Rate for Payer: Zelis Auto |
$2,555.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,194.00
|
|
|
IMPLT HEAD HUMERAL SIZE44 19MM
|
Facility
|
OP
|
$7,147.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001858
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,786.75 |
| Max. Negotiated Rate |
$6,789.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,288.20
|
| Rate for Payer: Cash Price |
$4,288.20
|
| Rate for Payer: Cash Price |
$4,288.20
|
| Rate for Payer: Cigna Commercial |
$6,074.95
|
| Rate for Payer: First Health Commercial |
$6,432.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,432.30
|
| Rate for Payer: GEHA Commercial |
$5,717.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,432.30
|
| Rate for Payer: Humana ChoiceCare |
$1,858.22
|
| Rate for Payer: Multiplan All |
$6,503.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,288.20
|
| Rate for Payer: OMNI Networks Commercial |
$5,002.90
|
| Rate for Payer: One Health Plan PPO/POS |
$6,432.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,789.65
|
| Rate for Payer: Three Rivers Provider Network All |
$5,360.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,289.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,786.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,646.71
|
| Rate for Payer: Zelis Auto |
$2,858.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,573.50
|
|
|
IMPLT HEAD HUMERAL SIZE44 19MM
|
Facility
|
IP
|
$7,147.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001858
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,858.80 |
| Max. Negotiated Rate |
$6,789.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,717.60
|
| Rate for Payer: Cash Price |
$4,288.20
|
| Rate for Payer: Cash Price |
$4,288.20
|
| Rate for Payer: Cigna Commercial |
$6,074.95
|
| Rate for Payer: First Health Commercial |
$6,432.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,432.30
|
| Rate for Payer: GEHA Commercial |
$5,002.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,432.30
|
| Rate for Payer: Multiplan All |
$6,503.77
|
| Rate for Payer: OMNI Networks Commercial |
$5,002.90
|
| Rate for Payer: One Health Plan PPO/POS |
$6,432.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,789.65
|
| Rate for Payer: Three Rivers Provider Network All |
$5,360.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,646.71
|
| Rate for Payer: Zelis Auto |
$2,858.80
|
|
|
IMPLT HEAD HUMERAL SIZE44 22MM
|
Facility
|
IP
|
$6,388.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002939
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,555.20 |
| Max. Negotiated Rate |
$6,068.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,110.40
|
| Rate for Payer: Cash Price |
$3,832.80
|
| Rate for Payer: Cash Price |
$3,832.80
|
| Rate for Payer: Cigna Commercial |
$5,429.80
|
| Rate for Payer: First Health Commercial |
$5,749.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,749.20
|
| Rate for Payer: GEHA Commercial |
$4,471.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,749.20
|
| Rate for Payer: Multiplan All |
$5,813.08
|
| Rate for Payer: OMNI Networks Commercial |
$4,471.60
|
| Rate for Payer: One Health Plan PPO/POS |
$5,749.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,068.60
|
| Rate for Payer: Three Rivers Provider Network All |
$4,791.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,940.84
|
| Rate for Payer: Zelis Auto |
$2,555.20
|
|
|
IMPLT HEAD HUMERAL SIZE44 22MM
|
Facility
|
OP
|
$6,388.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002939
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,597.00 |
| Max. Negotiated Rate |
$6,068.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,832.80
|
| Rate for Payer: Cash Price |
$3,832.80
|
| Rate for Payer: Cash Price |
$3,832.80
|
| Rate for Payer: Cigna Commercial |
$5,429.80
|
| Rate for Payer: First Health Commercial |
$5,749.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,749.20
|
| Rate for Payer: GEHA Commercial |
$5,110.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,749.20
|
| Rate for Payer: Humana ChoiceCare |
$1,660.88
|
| Rate for Payer: Multiplan All |
$5,813.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,832.80
|
| Rate for Payer: OMNI Networks Commercial |
$4,471.60
|
| Rate for Payer: One Health Plan PPO/POS |
$5,749.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,068.60
|
| Rate for Payer: Three Rivers Provider Network All |
$4,791.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,621.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,597.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,940.84
|
| Rate for Payer: Zelis Auto |
$2,555.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,194.00
|
|
|
IMPLT HEAD HUMERAL SIZE 44X22MM
|
Facility
|
OP
|
$6,388.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7007007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,597.00 |
| Max. Negotiated Rate |
$6,068.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,832.80
|
| Rate for Payer: Cash Price |
$3,832.80
|
| Rate for Payer: Cash Price |
$3,832.80
|
| Rate for Payer: Cigna Commercial |
$5,429.80
|
| Rate for Payer: First Health Commercial |
$5,749.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,749.20
|
| Rate for Payer: GEHA Commercial |
$5,110.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,749.20
|
| Rate for Payer: Humana ChoiceCare |
$1,660.88
|
| Rate for Payer: Multiplan All |
$5,813.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,832.80
|
| Rate for Payer: OMNI Networks Commercial |
$4,471.60
|
| Rate for Payer: One Health Plan PPO/POS |
$5,749.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,068.60
|
| Rate for Payer: Three Rivers Provider Network All |
$4,791.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,621.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,597.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,940.84
|
| Rate for Payer: Zelis Auto |
$2,555.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,194.00
|
|
|
IMPLT HEAD HUMERAL SIZE 44X22MM
|
Facility
|
IP
|
$6,388.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7007007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,555.20 |
| Max. Negotiated Rate |
$6,068.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,110.40
|
| Rate for Payer: Cash Price |
$3,832.80
|
| Rate for Payer: Cash Price |
$3,832.80
|
| Rate for Payer: Cigna Commercial |
$5,429.80
|
| Rate for Payer: First Health Commercial |
$5,749.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,749.20
|
| Rate for Payer: GEHA Commercial |
$4,471.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,749.20
|
| Rate for Payer: Multiplan All |
$5,813.08
|
| Rate for Payer: OMNI Networks Commercial |
$4,471.60
|
| Rate for Payer: One Health Plan PPO/POS |
$5,749.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,068.60
|
| Rate for Payer: Three Rivers Provider Network All |
$4,791.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,940.84
|
| Rate for Payer: Zelis Auto |
$2,555.20
|
|
|
IMPLT HEAD HUMERAL SIZE 48
|
Facility
|
OP
|
$9,662.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001854
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,415.50 |
| Max. Negotiated Rate |
$9,178.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,797.20
|
| Rate for Payer: Cash Price |
$5,797.20
|
| Rate for Payer: Cash Price |
$5,797.20
|
| Rate for Payer: Cigna Commercial |
$8,212.70
|
| Rate for Payer: First Health Commercial |
$8,695.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,695.80
|
| Rate for Payer: GEHA Commercial |
$7,729.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,695.80
|
| Rate for Payer: Humana ChoiceCare |
$2,512.12
|
| Rate for Payer: Multiplan All |
$8,792.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,797.20
|
| Rate for Payer: OMNI Networks Commercial |
$6,763.40
|
| Rate for Payer: One Health Plan PPO/POS |
$8,695.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9,178.90
|
| Rate for Payer: Three Rivers Provider Network All |
$7,246.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8,502.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,415.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,985.66
|
| Rate for Payer: Zelis Auto |
$3,864.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,831.00
|
|
