|
IMPLT HEAD MODULAR STANDARD 36MM
|
Facility
|
IP
|
$1,472.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
70090036
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$588.80 |
| Max. Negotiated Rate |
$1,398.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,177.60
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cigna Commercial |
$1,251.20
|
| Rate for Payer: First Health Commercial |
$1,324.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,324.80
|
| Rate for Payer: GEHA Commercial |
$1,030.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,324.80
|
| Rate for Payer: Multiplan All |
$1,339.52
|
| Rate for Payer: OMNI Networks Commercial |
$1,030.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,324.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,398.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,104.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,368.96
|
| Rate for Payer: Zelis Auto |
$588.80
|
|
|
IMPLT HEAD MODULAR STANDARD 36MM
|
Facility
|
OP
|
$4,141.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001862
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,035.25 |
| Max. Negotiated Rate |
$3,933.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,484.60
|
| Rate for Payer: Cash Price |
$2,484.60
|
| Rate for Payer: Cash Price |
$2,484.60
|
| Rate for Payer: Cigna Commercial |
$3,519.85
|
| Rate for Payer: First Health Commercial |
$3,726.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,726.90
|
| Rate for Payer: GEHA Commercial |
$3,312.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,726.90
|
| Rate for Payer: Humana ChoiceCare |
$1,076.66
|
| Rate for Payer: Multiplan All |
$3,768.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,484.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,898.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,726.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,933.95
|
| Rate for Payer: Three Rivers Provider Network All |
$3,105.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,644.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,035.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,851.13
|
| Rate for Payer: Zelis Auto |
$1,656.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,070.50
|
|
|
IMPLT HEAD MODULAR STANDARD 36MM
|
Facility
|
OP
|
$1,472.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
70090036
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$368.00 |
| Max. Negotiated Rate |
$1,398.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$883.20
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cigna Commercial |
$1,251.20
|
| Rate for Payer: First Health Commercial |
$1,324.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,324.80
|
| Rate for Payer: GEHA Commercial |
$1,177.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,324.80
|
| Rate for Payer: Humana ChoiceCare |
$382.72
|
| Rate for Payer: Multiplan All |
$1,339.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$883.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,030.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,324.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,398.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,104.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,295.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$368.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,368.96
|
| Rate for Payer: Zelis Auto |
$588.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$736.00
|
|
|
IMPLT HEAD MODULAR STANDARD 36MM
|
Facility
|
IP
|
$4,141.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001862
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,656.40 |
| Max. Negotiated Rate |
$3,933.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,312.80
|
| Rate for Payer: Cash Price |
$2,484.60
|
| Rate for Payer: Cash Price |
$2,484.60
|
| Rate for Payer: Cigna Commercial |
$3,519.85
|
| Rate for Payer: First Health Commercial |
$3,726.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,726.90
|
| Rate for Payer: GEHA Commercial |
$2,898.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,726.90
|
| Rate for Payer: Multiplan All |
$3,768.31
|
| Rate for Payer: OMNI Networks Commercial |
$2,898.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,726.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,933.95
|
| Rate for Payer: Three Rivers Provider Network All |
$3,105.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,851.13
|
| Rate for Payer: Zelis Auto |
$1,656.40
|
|
|
IMPLT HEAD MODULAR STANDARD 40MM
|
Facility
|
OP
|
$3,423.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$855.75 |
| Max. Negotiated Rate |
$3,251.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,053.80
|
| Rate for Payer: Cash Price |
$2,053.80
|
| Rate for Payer: Cash Price |
$2,053.80
|
| Rate for Payer: Cigna Commercial |
$2,909.55
|
| Rate for Payer: First Health Commercial |
$3,080.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,080.70
|
| Rate for Payer: GEHA Commercial |
$2,738.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,080.70
|
| Rate for Payer: Humana ChoiceCare |
$889.98
|
| Rate for Payer: Multiplan All |
$3,114.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,053.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,396.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,080.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,251.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2,567.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,012.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$855.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,183.39
|
| Rate for Payer: Zelis Auto |
$1,369.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,711.50
|
|
|
IMPLT HEAD MODULAR STANDARD 40MM
|
Facility
|
IP
|
$3,423.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,369.20 |
| Max. Negotiated Rate |
$3,251.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,738.40
|
| Rate for Payer: Cash Price |
$2,053.80
|
| Rate for Payer: Cash Price |
$2,053.80
|
| Rate for Payer: Cigna Commercial |
$2,909.55
|
| Rate for Payer: First Health Commercial |
$3,080.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,080.70
|
| Rate for Payer: GEHA Commercial |
$2,396.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,080.70
|
| Rate for Payer: Multiplan All |
$3,114.93
|
| Rate for Payer: OMNI Networks Commercial |
$2,396.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,080.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,251.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2,567.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,183.39
|
| Rate for Payer: Zelis Auto |
$1,369.20
|
|
|
IMPLT HEAD MODULAR TITANIUM 4MM
|
Facility
|
OP
|
$696.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001863
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$174.00 |
| Max. Negotiated Rate |
$661.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$417.60
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cigna Commercial |
$591.60
|
| Rate for Payer: First Health Commercial |
$626.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$626.40
|
| Rate for Payer: GEHA Commercial |
$556.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$626.40
|
| Rate for Payer: Humana ChoiceCare |
$180.96
|
| Rate for Payer: Multiplan All |
$633.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$417.60
|
| Rate for Payer: OMNI Networks Commercial |
$487.20
|
| Rate for Payer: One Health Plan PPO/POS |
$626.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$661.20
|
| Rate for Payer: Three Rivers Provider Network All |
$522.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$612.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$174.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$647.28
|
| Rate for Payer: Zelis Auto |
$278.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$348.00
|
|
|
IMPLT HEAD MODULAR TITANIUM 4MM
|
Facility
|
IP
|
$696.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001863
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$278.40 |
| Max. Negotiated Rate |
$661.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$556.80
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cigna Commercial |
$591.60
|
| Rate for Payer: First Health Commercial |
$626.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$626.40
|
| Rate for Payer: GEHA Commercial |
$487.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$626.40
|
| Rate for Payer: Multiplan All |
$633.36
|
| Rate for Payer: OMNI Networks Commercial |
$487.20
|
| Rate for Payer: One Health Plan PPO/POS |
$626.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$661.20
|
| Rate for Payer: Three Rivers Provider Network All |
$522.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$647.28
|
| Rate for Payer: Zelis Auto |
$278.40
|
|
|
IMPLT HEAD OFFSET TAPER SIZE26MM
|
Facility
|
IP
|
$2,081.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001865
|
|
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 OFFSET TAPER SIZE26MM
|
Facility
|
OP
|
$2,081.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001865
|
|
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 PLUS9 32MM MODULAR
|
Facility
|
IP
|
$1,919.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002032
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$767.60 |
| Max. Negotiated Rate |
$1,823.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,535.20
|
| Rate for Payer: Cash Price |
$1,151.40
|
| Rate for Payer: Cash Price |
$1,151.40
|
| Rate for Payer: Cigna Commercial |
$1,631.15
|
| Rate for Payer: First Health Commercial |
$1,727.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,727.10
|
| Rate for Payer: GEHA Commercial |
$1,343.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,727.10
|
| Rate for Payer: Multiplan All |
$1,746.29
|
| Rate for Payer: OMNI Networks Commercial |
$1,343.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,727.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,823.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,439.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,784.67
|
| Rate for Payer: Zelis Auto |
$767.60
|
|
|
IMPLT HEAD PLUS9 32MM MODULAR
|
Facility
|
OP
|
$1,919.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002032
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$479.75 |
| Max. Negotiated Rate |
$1,823.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,151.40
|
| Rate for Payer: Cash Price |
$1,151.40
|
| Rate for Payer: Cash Price |
$1,151.40
|
| Rate for Payer: Cigna Commercial |
$1,631.15
|
| Rate for Payer: First Health Commercial |
$1,727.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,727.10
|
| Rate for Payer: GEHA Commercial |
$1,535.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,727.10
|
| Rate for Payer: Humana ChoiceCare |
$498.94
|
| Rate for Payer: Multiplan All |
$1,746.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,151.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,343.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,727.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,823.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,439.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,688.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$479.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,784.67
|
| Rate for Payer: Zelis Auto |
$767.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$959.50
|
|
|
IMPLT HEAD UNIVERSAL 45X26MM
|
Facility
|
IP
|
$2,225.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002033
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$890.00 |
| Max. Negotiated Rate |
$2,113.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,780.00
|
| Rate for Payer: Cash Price |
$1,335.00
|
| Rate for Payer: Cash Price |
$1,335.00
|
| Rate for Payer: Cigna Commercial |
$1,891.25
|
| Rate for Payer: First Health Commercial |
$2,002.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,002.50
|
| Rate for Payer: GEHA Commercial |
$1,557.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,002.50
|
| Rate for Payer: Multiplan All |
$2,024.75
|
| Rate for Payer: OMNI Networks Commercial |
$1,557.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,002.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,113.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,668.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,069.25
|
| Rate for Payer: Zelis Auto |
$890.00
|
|
|
IMPLT HEAD UNIVERSAL 45X26MM
|
Facility
|
OP
|
$2,225.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002033
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$556.25 |
| Max. Negotiated Rate |
$2,113.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,335.00
|
| Rate for Payer: Cash Price |
$1,335.00
|
| Rate for Payer: Cash Price |
$1,335.00
|
| Rate for Payer: Cigna Commercial |
$1,891.25
|
| Rate for Payer: First Health Commercial |
$2,002.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,002.50
|
| Rate for Payer: GEHA Commercial |
$1,780.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,002.50
|
| Rate for Payer: Humana ChoiceCare |
$578.50
|
| Rate for Payer: Multiplan All |
$2,024.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,335.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,557.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,002.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,113.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,668.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,958.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$556.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,069.25
|
| Rate for Payer: Zelis Auto |
$890.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,112.50
|
|
|
IMPLT HEAD UNIVERSAL 51MMX28MM
|
Facility
|
IP
|
$2,817.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006512
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,126.80 |
| Max. Negotiated Rate |
$2,676.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,253.60
|
| Rate for Payer: Cash Price |
$1,690.20
|
| Rate for Payer: Cash Price |
$1,690.20
|
| Rate for Payer: Cigna Commercial |
$2,394.45
|
| Rate for Payer: First Health Commercial |
$2,535.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,535.30
|
| Rate for Payer: GEHA Commercial |
$1,971.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,535.30
|
| Rate for Payer: Multiplan All |
$2,563.47
|
| Rate for Payer: OMNI Networks Commercial |
$1,971.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,535.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,676.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,112.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,619.81
|
| Rate for Payer: Zelis Auto |
$1,126.80
|
|
|
IMPLT HEAD UNIVERSAL 51MMX28MM
|
Facility
|
OP
|
$2,817.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006512
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$704.25 |
| Max. Negotiated Rate |
$2,676.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,690.20
|
| Rate for Payer: Cash Price |
$1,690.20
|
| Rate for Payer: Cash Price |
$1,690.20
|
| Rate for Payer: Cigna Commercial |
$2,394.45
|
| Rate for Payer: First Health Commercial |
$2,535.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,535.30
|
| Rate for Payer: GEHA Commercial |
$2,253.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,535.30
|
| Rate for Payer: Humana ChoiceCare |
$732.42
|
| Rate for Payer: Multiplan All |
$2,563.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,690.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,971.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,535.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,676.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,112.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,478.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$704.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,619.81
|
| Rate for Payer: Zelis Auto |
$1,126.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,408.50
|
|
|
IMPLT HEAD UNIV UHR BIPOLAR 47MMX26MM
|
Facility
|
OP
|
$2,225.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002611
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$556.25 |
| Max. Negotiated Rate |
$2,113.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,335.00
|
| Rate for Payer: Cash Price |
$1,335.00
|
| Rate for Payer: Cash Price |
$1,335.00
|
| Rate for Payer: Cigna Commercial |
$1,891.25
|
| Rate for Payer: First Health Commercial |
$2,002.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,002.50
|
| Rate for Payer: GEHA Commercial |
$1,780.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,002.50
|
| Rate for Payer: Humana ChoiceCare |
$578.50
|
| Rate for Payer: Multiplan All |
$2,024.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,335.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,557.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,002.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,113.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,668.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,958.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$556.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,069.25
|
| Rate for Payer: Zelis Auto |
$890.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,112.50
|
|
|
IMPLT HEAD UNIV UHR BIPOLAR 47MMX26MM
|
Facility
|
IP
|
$2,225.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002611
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$890.00 |
| Max. Negotiated Rate |
$2,113.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,780.00
|
| Rate for Payer: Cash Price |
$1,335.00
|
| Rate for Payer: Cash Price |
$1,335.00
|
| Rate for Payer: Cigna Commercial |
$1,891.25
|
| Rate for Payer: First Health Commercial |
$2,002.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,002.50
|
| Rate for Payer: GEHA Commercial |
$1,557.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,002.50
|
| Rate for Payer: Multiplan All |
$2,024.75
|
| Rate for Payer: OMNI Networks Commercial |
$1,557.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,002.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,113.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,668.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,069.25
|
| Rate for Payer: Zelis Auto |
$890.00
|
|
|
IMPLT HEALICOIL 4.5MM W/2
|
Facility
|
IP
|
$1,679.00
|
|
|
Service Code
|
CPT C2617
|
| Hospital Charge Code |
7002427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$671.60 |
| Max. Negotiated Rate |
$1,595.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,343.20
|
| Rate for Payer: Cash Price |
$1,007.40
|
| Rate for Payer: Cash Price |
$1,007.40
|
| Rate for Payer: Cigna Commercial |
$1,427.15
|
| Rate for Payer: First Health Commercial |
$1,511.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,511.10
|
| Rate for Payer: GEHA Commercial |
$1,175.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,511.10
|
| Rate for Payer: Multiplan All |
$1,527.89
|
| Rate for Payer: OMNI Networks Commercial |
$1,175.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,511.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,595.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,259.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,561.47
|
| Rate for Payer: Zelis Auto |
$671.60
|
|
|
IMPLT HEALICOIL 4.5MM W/2
|
Facility
|
OP
|
$1,679.00
|
|
|
Service Code
|
CPT C2617
|
| Hospital Charge Code |
7002427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$419.75 |
| Max. Negotiated Rate |
$1,595.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,007.40
|
| Rate for Payer: Cash Price |
$1,007.40
|
| Rate for Payer: Cash Price |
$1,007.40
|
| Rate for Payer: Cigna Commercial |
$1,427.15
|
| Rate for Payer: First Health Commercial |
$1,511.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,511.10
|
| Rate for Payer: GEHA Commercial |
$1,343.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,511.10
|
| Rate for Payer: Humana ChoiceCare |
$436.54
|
| Rate for Payer: Multiplan All |
$1,527.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,007.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,175.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,511.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,595.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,259.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,477.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$419.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,561.47
|
| Rate for Payer: Zelis Auto |
$671.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$839.50
|
|
|
IMPLT HEALICOIL 5.5MM W/3
|
Facility
|
OP
|
$1,675.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002428
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$418.75 |
| Max. Negotiated Rate |
$1,591.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,005.00
|
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cigna Commercial |
$1,423.75
|
| Rate for Payer: First Health Commercial |
$1,507.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,507.50
|
| Rate for Payer: GEHA Commercial |
$1,340.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,507.50
|
| Rate for Payer: Humana ChoiceCare |
$435.50
|
| Rate for Payer: Multiplan All |
$1,524.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,005.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,172.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,507.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,591.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,256.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,474.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$418.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,557.75
|
| Rate for Payer: Zelis Auto |
$670.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$837.50
|
|
|
IMPLT HEALICOIL 5.5MM W/3
|
Facility
|
IP
|
$1,675.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002428
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.00 |
| Max. Negotiated Rate |
$1,591.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,340.00
|
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cigna Commercial |
$1,423.75
|
| Rate for Payer: First Health Commercial |
$1,507.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,507.50
|
| Rate for Payer: GEHA Commercial |
$1,172.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,507.50
|
| Rate for Payer: Multiplan All |
$1,524.25
|
| Rate for Payer: OMNI Networks Commercial |
$1,172.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,507.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,591.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,256.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,557.75
|
| Rate for Payer: Zelis Auto |
$670.00
|
|
|
IMPLT HEALICOIL 5.5MM W/ULTRATAPE
|
Facility
|
OP
|
$1,654.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7005194
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$413.50 |
| Max. Negotiated Rate |
$1,571.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$992.40
|
| Rate for Payer: Cash Price |
$992.40
|
| Rate for Payer: Cash Price |
$992.40
|
| Rate for Payer: Cigna Commercial |
$1,405.90
|
| Rate for Payer: First Health Commercial |
$1,488.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,488.60
|
| Rate for Payer: GEHA Commercial |
$1,323.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,488.60
|
| Rate for Payer: Humana ChoiceCare |
$430.04
|
| Rate for Payer: Multiplan All |
$1,505.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$992.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,157.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,488.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,571.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,240.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,455.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$413.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,538.22
|
| Rate for Payer: Zelis Auto |
$661.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$827.00
|
|
|
IMPLT HEALICOIL 5.5MM W/ULTRATAPE
|
Facility
|
IP
|
$1,654.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7005194
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$661.60 |
| Max. Negotiated Rate |
$1,571.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,323.20
|
| Rate for Payer: Cash Price |
$992.40
|
| Rate for Payer: Cash Price |
$992.40
|
| Rate for Payer: Cigna Commercial |
$1,405.90
|
| Rate for Payer: First Health Commercial |
$1,488.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,488.60
|
| Rate for Payer: GEHA Commercial |
$1,157.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,488.60
|
| Rate for Payer: Multiplan All |
$1,505.14
|
| Rate for Payer: OMNI Networks Commercial |
$1,157.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,488.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,571.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,240.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,538.22
|
| Rate for Payer: Zelis Auto |
$661.60
|
|
|
IMPLT HEALICOIL KNOTLESS 5.0 NONSELF
|
Facility
|
OP
|
$1,472.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009069
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$368.00 |
| Max. Negotiated Rate |
$1,398.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$883.20
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cigna Commercial |
$1,251.20
|
| Rate for Payer: First Health Commercial |
$1,324.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,324.80
|
| Rate for Payer: GEHA Commercial |
$1,177.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,324.80
|
| Rate for Payer: Humana ChoiceCare |
$382.72
|
| Rate for Payer: Multiplan All |
$1,339.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$883.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,030.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,324.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,398.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,104.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,295.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$368.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,368.96
|
| Rate for Payer: Zelis Auto |
$588.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$736.00
|
|
