|
IMPLT HEADLESS SCREW 4.0MM X 42MM
|
Facility
|
IP
|
$1,819.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009198
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$727.60 |
| Max. Negotiated Rate |
$1,728.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,455.20
|
| Rate for Payer: Cash Price |
$1,091.40
|
| Rate for Payer: Cash Price |
$1,091.40
|
| Rate for Payer: Cigna Commercial |
$1,546.15
|
| Rate for Payer: First Health Commercial |
$1,637.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,637.10
|
| Rate for Payer: GEHA Commercial |
$1,273.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,637.10
|
| Rate for Payer: Multiplan All |
$1,655.29
|
| Rate for Payer: OMNI Networks Commercial |
$1,273.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,637.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,728.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,364.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,691.67
|
| Rate for Payer: Zelis Auto |
$727.60
|
|
|
IMPLT HEADLESS SCREW 4.0MM X 42MM
|
Facility
|
OP
|
$1,819.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009198
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$454.75 |
| Max. Negotiated Rate |
$1,728.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,091.40
|
| Rate for Payer: Cash Price |
$1,091.40
|
| Rate for Payer: Cash Price |
$1,091.40
|
| Rate for Payer: Cigna Commercial |
$1,546.15
|
| Rate for Payer: First Health Commercial |
$1,637.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,637.10
|
| Rate for Payer: GEHA Commercial |
$1,455.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,637.10
|
| Rate for Payer: Humana ChoiceCare |
$472.94
|
| Rate for Payer: Multiplan All |
$1,655.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,091.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,273.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,637.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,728.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,364.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,600.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$454.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,691.67
|
| Rate for Payer: Zelis Auto |
$727.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$909.50
|
|
|
IMPLT HEADLESS SCREW 4.0MM X 42MM
|
Facility
|
OP
|
$1,819.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009199
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$454.75 |
| Max. Negotiated Rate |
$1,728.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,091.40
|
| Rate for Payer: Cash Price |
$1,091.40
|
| Rate for Payer: Cash Price |
$1,091.40
|
| Rate for Payer: Cigna Commercial |
$1,546.15
|
| Rate for Payer: First Health Commercial |
$1,637.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,637.10
|
| Rate for Payer: GEHA Commercial |
$1,455.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,637.10
|
| Rate for Payer: Humana ChoiceCare |
$472.94
|
| Rate for Payer: Multiplan All |
$1,655.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,091.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,273.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,637.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,728.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,364.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,600.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$454.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,691.67
|
| Rate for Payer: Zelis Auto |
$727.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$909.50
|
|
|
IMPLT HEADLESS SCREW 4.0MM X 46MM
|
Facility
|
OP
|
$1,819.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009200
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$454.75 |
| Max. Negotiated Rate |
$1,728.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,091.40
|
| Rate for Payer: Cash Price |
$1,091.40
|
| Rate for Payer: Cash Price |
$1,091.40
|
| Rate for Payer: Cigna Commercial |
$1,546.15
|
| Rate for Payer: First Health Commercial |
$1,637.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,637.10
|
| Rate for Payer: GEHA Commercial |
$1,455.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,637.10
|
| Rate for Payer: Humana ChoiceCare |
$472.94
|
| Rate for Payer: Multiplan All |
$1,655.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,091.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,273.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,637.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,728.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,364.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,600.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$454.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,691.67
|
| Rate for Payer: Zelis Auto |
$727.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$909.50
|
|
|
IMPLT HEADLESS SCREW 4.0MM X 46MM
|
Facility
|
IP
|
$1,819.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009200
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$727.60 |
| Max. Negotiated Rate |
$1,728.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,455.20
|
| Rate for Payer: Cash Price |
$1,091.40
|
| Rate for Payer: Cash Price |
$1,091.40
|
| Rate for Payer: Cigna Commercial |
$1,546.15
|
| Rate for Payer: First Health Commercial |
$1,637.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,637.10
|
| Rate for Payer: GEHA Commercial |
$1,273.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,637.10
|
| Rate for Payer: Multiplan All |
$1,655.29
|
| Rate for Payer: OMNI Networks Commercial |
$1,273.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,637.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,728.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,364.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,691.67
|
| Rate for Payer: Zelis Auto |
$727.60
|
|
|
IMPLT HEADLESS SCREW 4.0MM X 48MM
|
Facility
|
IP
|
$1,819.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$727.60 |
| Max. Negotiated Rate |
$1,728.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,455.20
|
| Rate for Payer: Cash Price |
$1,091.40
|
| Rate for Payer: Cash Price |
$1,091.40
|
| Rate for Payer: Cigna Commercial |
$1,546.15
|
| Rate for Payer: First Health Commercial |
$1,637.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,637.10
|
| Rate for Payer: GEHA Commercial |
$1,273.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,637.10
|
| Rate for Payer: Multiplan All |
$1,655.29
|
| Rate for Payer: OMNI Networks Commercial |
$1,273.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,637.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,728.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,364.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,691.67
|
| Rate for Payer: Zelis Auto |
$727.60
|
|
|
IMPLT HEADLESS SCREW 4.0MM X 48MM
|
Facility
|
OP
|
$1,819.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$454.75 |
| Max. Negotiated Rate |
$1,728.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,091.40
|
| Rate for Payer: Cash Price |
$1,091.40
|
| Rate for Payer: Cash Price |
$1,091.40
|
| Rate for Payer: Cigna Commercial |
$1,546.15
|
| Rate for Payer: First Health Commercial |
$1,637.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,637.10
|
| Rate for Payer: GEHA Commercial |
$1,455.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,637.10
|
| Rate for Payer: Humana ChoiceCare |
$472.94
|
| Rate for Payer: Multiplan All |
$1,655.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,091.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,273.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,637.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,728.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,364.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,600.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$454.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,691.67
|
| Rate for Payer: Zelis Auto |
$727.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$909.50
|
|
|
IMPLT HEADLESS SCREW 4.0MM X 50MM
|
Facility
|
IP
|
$1,819.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009202
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$727.60 |
| Max. Negotiated Rate |
$1,728.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,455.20
|
| Rate for Payer: Cash Price |
$1,091.40
|
| Rate for Payer: Cash Price |
$1,091.40
|
| Rate for Payer: Cigna Commercial |
$1,546.15
|
| Rate for Payer: First Health Commercial |
$1,637.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,637.10
|
| Rate for Payer: GEHA Commercial |
$1,273.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,637.10
|
| Rate for Payer: Multiplan All |
$1,655.29
|
| Rate for Payer: OMNI Networks Commercial |
$1,273.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,637.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,728.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,364.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,691.67
|
| Rate for Payer: Zelis Auto |
$727.60
|
|
|
IMPLT HEADLESS SCREW 4.0MM X 50MM
|
Facility
|
OP
|
$1,819.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009202
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$454.75 |
| Max. Negotiated Rate |
$1,728.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,091.40
|
| Rate for Payer: Cash Price |
$1,091.40
|
| Rate for Payer: Cash Price |
$1,091.40
|
| Rate for Payer: Cigna Commercial |
$1,546.15
|
| Rate for Payer: First Health Commercial |
$1,637.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,637.10
|
| Rate for Payer: GEHA Commercial |
$1,455.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,637.10
|
| Rate for Payer: Humana ChoiceCare |
$472.94
|
| Rate for Payer: Multiplan All |
$1,655.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,091.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,273.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,637.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,728.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,364.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,600.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$454.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,691.67
|
| Rate for Payer: Zelis Auto |
$727.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$909.50
|
|
|
IMPLT HEAD MODULAR 32MM
|
Facility
|
OP
|
$3,806.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001859
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$951.50 |
| Max. Negotiated Rate |
$3,615.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,283.60
|
| Rate for Payer: Cash Price |
$2,283.60
|
| Rate for Payer: Cash Price |
$2,283.60
|
| Rate for Payer: Cigna Commercial |
$3,235.10
|
| Rate for Payer: First Health Commercial |
$3,425.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,425.40
|
| Rate for Payer: GEHA Commercial |
$3,044.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,425.40
|
| Rate for Payer: Humana ChoiceCare |
$989.56
|
| Rate for Payer: Multiplan All |
$3,463.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,283.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,664.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,425.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,615.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,854.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,349.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$951.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,539.58
|
| Rate for Payer: Zelis Auto |
$1,522.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,903.00
|
|
|
IMPLT HEAD MODULAR 32MM
|
Facility
|
IP
|
$3,806.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001859
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,522.40 |
| Max. Negotiated Rate |
$3,615.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,044.80
|
| Rate for Payer: Cash Price |
$2,283.60
|
| Rate for Payer: Cash Price |
$2,283.60
|
| Rate for Payer: Cigna Commercial |
$3,235.10
|
| Rate for Payer: First Health Commercial |
$3,425.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,425.40
|
| Rate for Payer: GEHA Commercial |
$2,664.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,425.40
|
| Rate for Payer: Multiplan All |
$3,463.46
|
| Rate for Payer: OMNI Networks Commercial |
$2,664.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,425.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,615.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,854.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,539.58
|
| Rate for Payer: Zelis Auto |
$1,522.40
|
|
|
IMPLT HEAD MODULAR 32MM PLUS 3
|
Facility
|
IP
|
$508.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001860
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$203.20 |
| Max. Negotiated Rate |
$482.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$406.40
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$431.80
|
| Rate for Payer: First Health Commercial |
$457.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$457.20
|
| Rate for Payer: GEHA Commercial |
$355.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$457.20
|
| Rate for Payer: Multiplan All |
$462.28
|
| Rate for Payer: OMNI Networks Commercial |
$355.60
|
| Rate for Payer: One Health Plan PPO/POS |
$457.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$482.60
|
| Rate for Payer: Three Rivers Provider Network All |
$381.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$472.44
|
| Rate for Payer: Zelis Auto |
$203.20
|
|
|
IMPLT HEAD MODULAR 32MM PLUS 3
|
Facility
|
OP
|
$508.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001860
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$127.00 |
| Max. Negotiated Rate |
$482.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$304.80
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$431.80
|
| Rate for Payer: First Health Commercial |
$457.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$457.20
|
| Rate for Payer: GEHA Commercial |
$406.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$457.20
|
| Rate for Payer: Humana ChoiceCare |
$132.08
|
| Rate for Payer: Multiplan All |
$462.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$304.80
|
| Rate for Payer: OMNI Networks Commercial |
$355.60
|
| Rate for Payer: One Health Plan PPO/POS |
$457.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$482.60
|
| Rate for Payer: Three Rivers Provider Network All |
$381.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$447.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$127.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$472.44
|
| Rate for Payer: Zelis Auto |
$203.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$254.00
|
|
|
IMPLT HEAD MODULAR 36MM PLUS 3
|
Facility
|
IP
|
$2,536.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,014.40 |
| Max. Negotiated Rate |
$2,409.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,028.80
|
| Rate for Payer: Cash Price |
$1,521.60
|
| Rate for Payer: Cash Price |
$1,521.60
|
| Rate for Payer: Cigna Commercial |
$2,155.60
|
| Rate for Payer: First Health Commercial |
$2,282.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,282.40
|
| Rate for Payer: GEHA Commercial |
$1,775.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,282.40
|
| Rate for Payer: Multiplan All |
$2,307.76
|
| Rate for Payer: OMNI Networks Commercial |
$1,775.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,282.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,409.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,902.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,358.48
|
| Rate for Payer: Zelis Auto |
$1,014.40
|
|
|
IMPLT HEAD MODULAR 36MM PLUS 3
|
Facility
|
OP
|
$2,536.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$634.00 |
| Max. Negotiated Rate |
$2,409.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,521.60
|
| Rate for Payer: Cash Price |
$1,521.60
|
| Rate for Payer: Cash Price |
$1,521.60
|
| Rate for Payer: Cigna Commercial |
$2,155.60
|
| Rate for Payer: First Health Commercial |
$2,282.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,282.40
|
| Rate for Payer: GEHA Commercial |
$2,028.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,282.40
|
| Rate for Payer: Humana ChoiceCare |
$659.36
|
| Rate for Payer: Multiplan All |
$2,307.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,521.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,775.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,282.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,409.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,902.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,231.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$634.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,358.48
|
| Rate for Payer: Zelis Auto |
$1,014.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,268.00
|
|
|
IMPLT HEAD MODULAR 36MM PLUS9MM
|
Facility
|
OP
|
$912.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001864
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$228.00 |
| Max. Negotiated Rate |
$866.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$547.20
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cigna Commercial |
$775.20
|
| Rate for Payer: First Health Commercial |
$820.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$820.80
|
| Rate for Payer: GEHA Commercial |
$729.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$820.80
|
| Rate for Payer: Humana ChoiceCare |
$237.12
|
| Rate for Payer: Multiplan All |
$829.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$547.20
|
| Rate for Payer: OMNI Networks Commercial |
$638.40
|
| Rate for Payer: One Health Plan PPO/POS |
$820.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$866.40
|
| Rate for Payer: Three Rivers Provider Network All |
$684.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$802.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$228.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$848.16
|
| Rate for Payer: Zelis Auto |
$364.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$456.00
|
|
|
IMPLT HEAD MODULAR 36MM PLUS9MM
|
Facility
|
IP
|
$912.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001864
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$364.80 |
| Max. Negotiated Rate |
$866.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$729.60
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cigna Commercial |
$775.20
|
| Rate for Payer: First Health Commercial |
$820.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$820.80
|
| Rate for Payer: GEHA Commercial |
$638.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$820.80
|
| Rate for Payer: Multiplan All |
$829.92
|
| Rate for Payer: OMNI Networks Commercial |
$638.40
|
| Rate for Payer: One Health Plan PPO/POS |
$820.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$866.40
|
| Rate for Payer: Three Rivers Provider Network All |
$684.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$848.16
|
| Rate for Payer: Zelis Auto |
$364.80
|
|
|
IMPLT HEAD MODULAR COMPONENT 32MM
|
Facility
|
IP
|
$2,360.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$944.00 |
| Max. Negotiated Rate |
$2,242.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,888.00
|
| Rate for Payer: Cash Price |
$1,416.00
|
| Rate for Payer: Cash Price |
$1,416.00
|
| Rate for Payer: Cigna Commercial |
$2,006.00
|
| Rate for Payer: First Health Commercial |
$2,124.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,124.00
|
| Rate for Payer: GEHA Commercial |
$1,652.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,124.00
|
| Rate for Payer: Multiplan All |
$2,147.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,652.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,124.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,242.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,770.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,194.80
|
| Rate for Payer: Zelis Auto |
$944.00
|
|
|
IMPLT HEAD MODULAR COMPONENT 32MM
|
Facility
|
OP
|
$2,360.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$590.00 |
| Max. Negotiated Rate |
$2,242.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,416.00
|
| Rate for Payer: Cash Price |
$1,416.00
|
| Rate for Payer: Cash Price |
$1,416.00
|
| Rate for Payer: Cigna Commercial |
$2,006.00
|
| Rate for Payer: First Health Commercial |
$2,124.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,124.00
|
| Rate for Payer: GEHA Commercial |
$1,888.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,124.00
|
| Rate for Payer: Humana ChoiceCare |
$613.60
|
| Rate for Payer: Multiplan All |
$2,147.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,416.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,652.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,124.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,242.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,770.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,076.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$590.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,194.80
|
| Rate for Payer: Zelis Auto |
$944.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,180.00
|
|
|
IMPLT HEAD MODULAR OFFSET 42X24MM
|
Facility
|
IP
|
$7,150.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001861
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,860.00 |
| Max. Negotiated Rate |
$6,792.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,720.00
|
| Rate for Payer: Cash Price |
$4,290.00
|
| Rate for Payer: Cash Price |
$4,290.00
|
| Rate for Payer: Cigna Commercial |
$6,077.50
|
| Rate for Payer: First Health Commercial |
$6,435.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,435.00
|
| Rate for Payer: GEHA Commercial |
$5,005.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,435.00
|
| Rate for Payer: Multiplan All |
$6,506.50
|
| Rate for Payer: OMNI Networks Commercial |
$5,005.00
|
| Rate for Payer: One Health Plan PPO/POS |
$6,435.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,792.50
|
| Rate for Payer: Three Rivers Provider Network All |
$5,362.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,649.50
|
| Rate for Payer: Zelis Auto |
$2,860.00
|
|
|
IMPLT HEAD MODULAR OFFSET 42X24MM
|
Facility
|
OP
|
$7,150.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001861
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,787.50 |
| Max. Negotiated Rate |
$6,792.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,290.00
|
| Rate for Payer: Cash Price |
$4,290.00
|
| Rate for Payer: Cash Price |
$4,290.00
|
| Rate for Payer: Cigna Commercial |
$6,077.50
|
| Rate for Payer: First Health Commercial |
$6,435.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,435.00
|
| Rate for Payer: GEHA Commercial |
$5,720.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,435.00
|
| Rate for Payer: Humana ChoiceCare |
$1,859.00
|
| Rate for Payer: Multiplan All |
$6,506.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,290.00
|
| Rate for Payer: OMNI Networks Commercial |
$5,005.00
|
| Rate for Payer: One Health Plan PPO/POS |
$6,435.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,792.50
|
| Rate for Payer: Three Rivers Provider Network All |
$5,362.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,292.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,787.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,649.50
|
| Rate for Payer: Zelis Auto |
$2,860.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,575.00
|
|
|
IMPLT HEAD MODULAR OFFSET VARIABLE
|
Facility
|
OP
|
$8,167.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002566
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,041.75 |
| Max. Negotiated Rate |
$7,758.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,900.20
|
| Rate for Payer: Cash Price |
$4,900.20
|
| Rate for Payer: Cash Price |
$4,900.20
|
| Rate for Payer: Cigna Commercial |
$6,941.95
|
| Rate for Payer: First Health Commercial |
$7,350.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,350.30
|
| Rate for Payer: GEHA Commercial |
$6,533.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,350.30
|
| Rate for Payer: Humana ChoiceCare |
$2,123.42
|
| Rate for Payer: Multiplan All |
$7,431.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,900.20
|
| Rate for Payer: OMNI Networks Commercial |
$5,716.90
|
| Rate for Payer: One Health Plan PPO/POS |
$7,350.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,758.65
|
| Rate for Payer: Three Rivers Provider Network All |
$6,125.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,186.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,041.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,595.31
|
| Rate for Payer: Zelis Auto |
$3,266.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,083.50
|
|
|
IMPLT HEAD MODULAR OFFSET VARIABLE
|
Facility
|
IP
|
$8,167.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002566
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,266.80 |
| Max. Negotiated Rate |
$7,758.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,533.60
|
| Rate for Payer: Cash Price |
$4,900.20
|
| Rate for Payer: Cash Price |
$4,900.20
|
| Rate for Payer: Cigna Commercial |
$6,941.95
|
| Rate for Payer: First Health Commercial |
$7,350.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,350.30
|
| Rate for Payer: GEHA Commercial |
$5,716.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,350.30
|
| Rate for Payer: Multiplan All |
$7,431.97
|
| Rate for Payer: OMNI Networks Commercial |
$5,716.90
|
| Rate for Payer: One Health Plan PPO/POS |
$7,350.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,758.65
|
| Rate for Payer: Three Rivers Provider Network All |
$6,125.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,595.31
|
| Rate for Payer: Zelis Auto |
$3,266.80
|
|
|
IMPLT HEAD MODULAR OXINIUM 44MM
|
Facility
|
IP
|
$5,542.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002031
|
|
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 MODULAR OXINIUM 44MM
|
Facility
|
OP
|
$5,542.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002031
|
|
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
|
|
