|
IMPLT HYDROSET 5CC
|
Facility
|
IP
|
$4,874.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,949.60 |
| Max. Negotiated Rate |
$4,630.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,899.20
|
| Rate for Payer: Cash Price |
$2,924.40
|
| Rate for Payer: Cash Price |
$2,924.40
|
| Rate for Payer: Cigna Commercial |
$4,142.90
|
| Rate for Payer: First Health Commercial |
$4,386.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,386.60
|
| Rate for Payer: GEHA Commercial |
$3,411.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,386.60
|
| Rate for Payer: Multiplan All |
$4,435.34
|
| Rate for Payer: OMNI Networks Commercial |
$3,411.80
|
| Rate for Payer: One Health Plan PPO/POS |
$4,386.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,630.30
|
| Rate for Payer: Three Rivers Provider Network All |
$3,655.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,532.82
|
| Rate for Payer: Zelis Auto |
$1,949.60
|
|
|
IMPLT HYDROSET 5CC
|
Facility
|
OP
|
$4,874.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,218.50 |
| Max. Negotiated Rate |
$4,630.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,924.40
|
| Rate for Payer: Cash Price |
$2,924.40
|
| Rate for Payer: Cash Price |
$2,924.40
|
| Rate for Payer: Cigna Commercial |
$4,142.90
|
| Rate for Payer: First Health Commercial |
$4,386.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,386.60
|
| Rate for Payer: GEHA Commercial |
$3,899.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,386.60
|
| Rate for Payer: Humana ChoiceCare |
$1,267.24
|
| Rate for Payer: Multiplan All |
$4,435.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,924.40
|
| Rate for Payer: OMNI Networks Commercial |
$3,411.80
|
| Rate for Payer: One Health Plan PPO/POS |
$4,386.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,630.30
|
| Rate for Payer: Three Rivers Provider Network All |
$3,655.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,289.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,218.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,532.82
|
| Rate for Payer: Zelis Auto |
$1,949.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,437.00
|
|
|
IMPLT ILIAC CREST STRIP LG 3.2X11.7
|
Facility
|
IP
|
$2,891.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002851
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$789.24 |
| Max. Negotiated Rate |
$2,746.45 |
| Rate for Payer: Cash Price |
$1,734.60
|
| Rate for Payer: Cigna Commercial |
$2,457.35
|
| Rate for Payer: First Health Commercial |
$2,601.90
|
| Rate for Payer: First Health Workers Compensation |
$1,116.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,601.90
|
| Rate for Payer: GEHA Commercial |
$2,023.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,601.90
|
| Rate for Payer: Multiplan All |
$2,630.81
|
| Rate for Payer: OMNI Networks Commercial |
$2,023.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,601.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,746.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,168.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,688.63
|
| Rate for Payer: Zelis Auto |
$1,156.40
|
| Rate for Payer: Zelis Worker's Compensation |
$789.24
|
|
|
IMPLT ILIAC CREST STRIP LG 3.2X11.7
|
Facility
|
OP
|
$2,891.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002851
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$722.75 |
| Max. Negotiated Rate |
$2,746.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,734.60
|
| Rate for Payer: Cash Price |
$1,734.60
|
| Rate for Payer: Cigna Commercial |
$2,457.35
|
| Rate for Payer: First Health Commercial |
$2,601.90
|
| Rate for Payer: First Health Workers Compensation |
$1,116.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,601.90
|
| Rate for Payer: GEHA Commercial |
$2,312.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,601.90
|
| Rate for Payer: Humana ChoiceCare |
$751.66
|
| Rate for Payer: Multiplan All |
$2,630.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,734.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,023.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,601.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,746.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,168.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,544.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$722.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,688.63
|
| Rate for Payer: Zelis Auto |
$1,156.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,445.50
|
| Rate for Payer: Zelis Worker's Compensation |
$789.24
|
|
|
IMPLT IMPACTOR FEMORAL
|
Facility
|
IP
|
$1,214.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$485.60 |
| Max. Negotiated Rate |
$1,153.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$971.20
|
| Rate for Payer: Cash Price |
$728.40
|
| Rate for Payer: Cash Price |
$728.40
|
| Rate for Payer: Cigna Commercial |
$1,031.90
|
| Rate for Payer: First Health Commercial |
$1,092.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,092.60
|
| Rate for Payer: GEHA Commercial |
$849.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,092.60
|
| Rate for Payer: Multiplan All |
$1,104.74
|
| Rate for Payer: OMNI Networks Commercial |
$849.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,092.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,153.30
|
| Rate for Payer: Three Rivers Provider Network All |
$910.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,129.02
|
| Rate for Payer: Zelis Auto |
$485.60
|
|
|
IMPLT IMPACTOR FEMORAL
|
Facility
|
OP
|
$1,214.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$303.50 |
| Max. Negotiated Rate |
$1,153.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$728.40
|
| Rate for Payer: Cash Price |
$728.40
|
| Rate for Payer: Cash Price |
$728.40
|
| Rate for Payer: Cigna Commercial |
$1,031.90
|
| Rate for Payer: First Health Commercial |
$1,092.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,092.60
|
| Rate for Payer: GEHA Commercial |
$971.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,092.60
|
| Rate for Payer: Humana ChoiceCare |
$315.64
|
| Rate for Payer: Multiplan All |
$1,104.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$728.40
|
| Rate for Payer: OMNI Networks Commercial |
$849.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,092.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,153.30
|
| Rate for Payer: Three Rivers Provider Network All |
$910.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,068.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$303.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,129.02
|
| Rate for Payer: Zelis Auto |
$485.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$607.00
|
|
|
IMPLT IMP SUBTALAR HORIZON 8MM
|
Facility
|
OP
|
$4,568.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001866
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.00 |
| Max. Negotiated Rate |
$4,339.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,740.80
|
| Rate for Payer: Cash Price |
$2,740.80
|
| Rate for Payer: Cash Price |
$2,740.80
|
| Rate for Payer: Cigna Commercial |
$3,882.80
|
| Rate for Payer: First Health Commercial |
$4,111.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,111.20
|
| Rate for Payer: GEHA Commercial |
$3,654.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,111.20
|
| Rate for Payer: Humana ChoiceCare |
$1,187.68
|
| Rate for Payer: Multiplan All |
$4,156.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,740.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,197.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,111.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,339.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,426.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,019.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,142.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,248.24
|
| Rate for Payer: Zelis Auto |
$1,827.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,284.00
|
|
|
IMPLT IMP SUBTALAR HORIZON 8MM
|
Facility
|
IP
|
$4,568.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001866
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,827.20 |
| Max. Negotiated Rate |
$4,339.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,654.40
|
| Rate for Payer: Cash Price |
$2,740.80
|
| Rate for Payer: Cash Price |
$2,740.80
|
| Rate for Payer: Cigna Commercial |
$3,882.80
|
| Rate for Payer: First Health Commercial |
$4,111.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,111.20
|
| Rate for Payer: GEHA Commercial |
$3,197.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,111.20
|
| Rate for Payer: Multiplan All |
$4,156.88
|
| Rate for Payer: OMNI Networks Commercial |
$3,197.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,111.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,339.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,426.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,248.24
|
| Rate for Payer: Zelis Auto |
$1,827.20
|
|
|
IMPLT INSERT ADM/MDM RESTOR SZ 46F
|
Facility
|
IP
|
$3,578.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,431.20 |
| Max. Negotiated Rate |
$3,399.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,862.40
|
| Rate for Payer: Cash Price |
$2,146.80
|
| Rate for Payer: Cash Price |
$2,146.80
|
| Rate for Payer: Cigna Commercial |
$3,041.30
|
| Rate for Payer: First Health Commercial |
$3,220.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,220.20
|
| Rate for Payer: GEHA Commercial |
$2,504.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,220.20
|
| Rate for Payer: Multiplan All |
$3,255.98
|
| Rate for Payer: OMNI Networks Commercial |
$2,504.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,220.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,399.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,683.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,327.54
|
| Rate for Payer: Zelis Auto |
$1,431.20
|
|
|
IMPLT INSERT ADM/MDM RESTOR SZ 46F
|
Facility
|
OP
|
$3,578.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$894.50 |
| Max. Negotiated Rate |
$3,399.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,146.80
|
| Rate for Payer: Cash Price |
$2,146.80
|
| Rate for Payer: Cash Price |
$2,146.80
|
| Rate for Payer: Cigna Commercial |
$3,041.30
|
| Rate for Payer: First Health Commercial |
$3,220.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,220.20
|
| Rate for Payer: GEHA Commercial |
$2,862.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,220.20
|
| Rate for Payer: Humana ChoiceCare |
$930.28
|
| Rate for Payer: Multiplan All |
$3,255.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,146.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,504.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,220.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,399.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,683.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,148.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$894.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,327.54
|
| Rate for Payer: Zelis Auto |
$1,431.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,789.00
|
|
|
IMPLT INSERT ARTICULAR FLEXION SIZE 3-4
|
Facility
|
IP
|
$3,685.68
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,474.27 |
| Max. Negotiated Rate |
$3,501.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,948.54
|
| Rate for Payer: Cash Price |
$2,211.41
|
| Rate for Payer: Cash Price |
$2,211.41
|
| Rate for Payer: Cigna Commercial |
$3,132.83
|
| Rate for Payer: First Health Commercial |
$3,317.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,317.11
|
| Rate for Payer: GEHA Commercial |
$2,579.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,317.11
|
| Rate for Payer: Multiplan All |
$3,353.97
|
| Rate for Payer: OMNI Networks Commercial |
$2,579.98
|
| Rate for Payer: One Health Plan PPO/POS |
$3,317.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,501.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,764.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,427.68
|
| Rate for Payer: Zelis Auto |
$1,474.27
|
|
|
IMPLT INSERT ARTICULAR FLEXION SIZE 3-4
|
Facility
|
OP
|
$3,685.68
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$921.42 |
| Max. Negotiated Rate |
$3,501.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,211.41
|
| Rate for Payer: Cash Price |
$2,211.41
|
| Rate for Payer: Cash Price |
$2,211.41
|
| Rate for Payer: Cigna Commercial |
$3,132.83
|
| Rate for Payer: First Health Commercial |
$3,317.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,317.11
|
| Rate for Payer: GEHA Commercial |
$2,948.54
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,317.11
|
| Rate for Payer: Humana ChoiceCare |
$958.28
|
| Rate for Payer: Multiplan All |
$3,353.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,211.41
|
| Rate for Payer: OMNI Networks Commercial |
$2,579.98
|
| Rate for Payer: One Health Plan PPO/POS |
$3,317.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,501.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,764.26
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,243.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$921.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,427.68
|
| Rate for Payer: Zelis Auto |
$1,474.27
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,842.84
|
|
|
IMPLT INSERT ARTICULAR FLEXION SIZE 3-4
|
Facility
|
OP
|
$3,045.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002036
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$761.25 |
| Max. Negotiated Rate |
$2,892.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,827.00
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna Commercial |
$2,588.25
|
| Rate for Payer: First Health Commercial |
$2,740.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,740.50
|
| Rate for Payer: GEHA Commercial |
$2,436.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,740.50
|
| Rate for Payer: Humana ChoiceCare |
$791.70
|
| Rate for Payer: Multiplan All |
$2,770.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,827.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,131.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,740.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,892.75
|
| Rate for Payer: Three Rivers Provider Network All |
$2,283.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,679.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$761.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,831.85
|
| Rate for Payer: Zelis Auto |
$1,218.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,522.50
|
|
|
IMPLT INSERT ARTICULAR FLEXION SIZE 3-4
|
Facility
|
IP
|
$3,045.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002036
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,218.00 |
| Max. Negotiated Rate |
$2,892.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,436.00
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna Commercial |
$2,588.25
|
| Rate for Payer: First Health Commercial |
$2,740.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,740.50
|
| Rate for Payer: GEHA Commercial |
$2,131.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,740.50
|
| Rate for Payer: Multiplan All |
$2,770.95
|
| Rate for Payer: OMNI Networks Commercial |
$2,131.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,740.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,892.75
|
| Rate for Payer: Three Rivers Provider Network All |
$2,283.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,831.85
|
| Rate for Payer: Zelis Auto |
$1,218.00
|
|
|
IMPLT INSERT BEARING SIZE 7 11MM
|
Facility
|
OP
|
$3,654.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7004283
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$913.50 |
| Max. Negotiated Rate |
$3,471.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,192.40
|
| Rate for Payer: Cash Price |
$2,192.40
|
| Rate for Payer: Cash Price |
$2,192.40
|
| Rate for Payer: Cigna Commercial |
$3,105.90
|
| Rate for Payer: First Health Commercial |
$3,288.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,288.60
|
| Rate for Payer: GEHA Commercial |
$2,923.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,288.60
|
| Rate for Payer: Humana ChoiceCare |
$950.04
|
| Rate for Payer: Multiplan All |
$3,325.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,192.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,557.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,288.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,471.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,740.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,215.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$913.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,398.22
|
| Rate for Payer: Zelis Auto |
$1,461.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,827.00
|
|
|
IMPLT INSERT BEARING SIZE 7 11MM
|
Facility
|
IP
|
$3,654.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7004283
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,461.60 |
| Max. Negotiated Rate |
$3,471.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,923.20
|
| Rate for Payer: Cash Price |
$2,192.40
|
| Rate for Payer: Cash Price |
$2,192.40
|
| Rate for Payer: Cigna Commercial |
$3,105.90
|
| Rate for Payer: First Health Commercial |
$3,288.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,288.60
|
| Rate for Payer: GEHA Commercial |
$2,557.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,288.60
|
| Rate for Payer: Multiplan All |
$3,325.14
|
| Rate for Payer: OMNI Networks Commercial |
$2,557.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,288.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,471.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,740.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,398.22
|
| Rate for Payer: Zelis Auto |
$1,461.60
|
|
|
IMPLT INSERT BEARING SIZE 7 13MM
|
Facility
|
IP
|
$3,654.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002194
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,461.60 |
| Max. Negotiated Rate |
$3,471.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,923.20
|
| Rate for Payer: Cash Price |
$2,192.40
|
| Rate for Payer: Cash Price |
$2,192.40
|
| Rate for Payer: Cigna Commercial |
$3,105.90
|
| Rate for Payer: First Health Commercial |
$3,288.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,288.60
|
| Rate for Payer: GEHA Commercial |
$2,557.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,288.60
|
| Rate for Payer: Multiplan All |
$3,325.14
|
| Rate for Payer: OMNI Networks Commercial |
$2,557.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,288.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,471.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,740.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,398.22
|
| Rate for Payer: Zelis Auto |
$1,461.60
|
|
|
IMPLT INSERT BEARING SIZE 7 13MM
|
Facility
|
OP
|
$3,654.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002194
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$913.50 |
| Max. Negotiated Rate |
$3,471.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,192.40
|
| Rate for Payer: Cash Price |
$2,192.40
|
| Rate for Payer: Cash Price |
$2,192.40
|
| Rate for Payer: Cigna Commercial |
$3,105.90
|
| Rate for Payer: First Health Commercial |
$3,288.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,288.60
|
| Rate for Payer: GEHA Commercial |
$2,923.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,288.60
|
| Rate for Payer: Humana ChoiceCare |
$950.04
|
| Rate for Payer: Multiplan All |
$3,325.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,192.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,557.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,288.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,471.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,740.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,215.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$913.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,398.22
|
| Rate for Payer: Zelis Auto |
$1,461.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,827.00
|
|
|
IMPLT INSERT BEARING TIBIAL
|
Facility
|
IP
|
$3,654.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002196
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,461.60 |
| Max. Negotiated Rate |
$3,471.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,923.20
|
| Rate for Payer: Cash Price |
$2,192.40
|
| Rate for Payer: Cash Price |
$2,192.40
|
| Rate for Payer: Cigna Commercial |
$3,105.90
|
| Rate for Payer: First Health Commercial |
$3,288.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,288.60
|
| Rate for Payer: GEHA Commercial |
$2,557.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,288.60
|
| Rate for Payer: Multiplan All |
$3,325.14
|
| Rate for Payer: OMNI Networks Commercial |
$2,557.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,288.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,471.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,740.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,398.22
|
| Rate for Payer: Zelis Auto |
$1,461.60
|
|
|
IMPLT INSERT BEARING TIBIAL
|
Facility
|
OP
|
$3,654.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002196
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$913.50 |
| Max. Negotiated Rate |
$3,471.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,192.40
|
| Rate for Payer: Cash Price |
$2,192.40
|
| Rate for Payer: Cash Price |
$2,192.40
|
| Rate for Payer: Cigna Commercial |
$3,105.90
|
| Rate for Payer: First Health Commercial |
$3,288.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,288.60
|
| Rate for Payer: GEHA Commercial |
$2,923.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,288.60
|
| Rate for Payer: Humana ChoiceCare |
$950.04
|
| Rate for Payer: Multiplan All |
$3,325.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,192.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,557.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,288.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,471.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,740.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,215.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$913.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,398.22
|
| Rate for Payer: Zelis Auto |
$1,461.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,827.00
|
|
|
IMPLT INSERT BEARING TIBIAL 12MM SZE 3
|
Facility
|
OP
|
$3,654.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003426
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$913.50 |
| Max. Negotiated Rate |
$3,471.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,192.40
|
| Rate for Payer: Cash Price |
$2,192.40
|
| Rate for Payer: Cash Price |
$2,192.40
|
| Rate for Payer: Cigna Commercial |
$3,105.90
|
| Rate for Payer: First Health Commercial |
$3,288.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,288.60
|
| Rate for Payer: GEHA Commercial |
$2,923.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,288.60
|
| Rate for Payer: Humana ChoiceCare |
$950.04
|
| Rate for Payer: Multiplan All |
$3,325.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,192.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,557.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,288.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,471.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,740.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,215.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$913.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,398.22
|
| Rate for Payer: Zelis Auto |
$1,461.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,827.00
|
|
|
IMPLT INSERT BEARING TIBIAL 12MM SZE 3
|
Facility
|
IP
|
$3,654.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003426
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,461.60 |
| Max. Negotiated Rate |
$3,471.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,923.20
|
| Rate for Payer: Cash Price |
$2,192.40
|
| Rate for Payer: Cash Price |
$2,192.40
|
| Rate for Payer: Cigna Commercial |
$3,105.90
|
| Rate for Payer: First Health Commercial |
$3,288.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,288.60
|
| Rate for Payer: GEHA Commercial |
$2,557.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,288.60
|
| Rate for Payer: Multiplan All |
$3,325.14
|
| Rate for Payer: OMNI Networks Commercial |
$2,557.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,288.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,471.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,740.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,398.22
|
| Rate for Payer: Zelis Auto |
$1,461.60
|
|
|
IMPLT INSERT BEARING TIBIAL 13MM SZE 3
|
Facility
|
IP
|
$3,654.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003098
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,461.60 |
| Max. Negotiated Rate |
$3,471.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,923.20
|
| Rate for Payer: Cash Price |
$2,192.40
|
| Rate for Payer: Cash Price |
$2,192.40
|
| Rate for Payer: Cigna Commercial |
$3,105.90
|
| Rate for Payer: First Health Commercial |
$3,288.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,288.60
|
| Rate for Payer: GEHA Commercial |
$2,557.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,288.60
|
| Rate for Payer: Multiplan All |
$3,325.14
|
| Rate for Payer: OMNI Networks Commercial |
$2,557.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,288.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,471.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,740.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,398.22
|
| Rate for Payer: Zelis Auto |
$1,461.60
|
|
|
IMPLT INSERT BEARING TIBIAL 13MM SZE 3
|
Facility
|
OP
|
$3,654.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003098
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$913.50 |
| Max. Negotiated Rate |
$3,471.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,192.40
|
| Rate for Payer: Cash Price |
$2,192.40
|
| Rate for Payer: Cash Price |
$2,192.40
|
| Rate for Payer: Cigna Commercial |
$3,105.90
|
| Rate for Payer: First Health Commercial |
$3,288.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,288.60
|
| Rate for Payer: GEHA Commercial |
$2,923.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,288.60
|
| Rate for Payer: Humana ChoiceCare |
$950.04
|
| Rate for Payer: Multiplan All |
$3,325.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,192.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,557.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,288.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,471.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,740.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,215.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$913.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,398.22
|
| Rate for Payer: Zelis Auto |
$1,461.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,827.00
|
|
|
IMPLT INSERT BEARING TIBIAL 3 SIZE
|
Facility
|
OP
|
$3,654.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002602
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$913.50 |
| Max. Negotiated Rate |
$3,471.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,192.40
|
| Rate for Payer: Cash Price |
$2,192.40
|
| Rate for Payer: Cash Price |
$2,192.40
|
| Rate for Payer: Cigna Commercial |
$3,105.90
|
| Rate for Payer: First Health Commercial |
$3,288.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,288.60
|
| Rate for Payer: GEHA Commercial |
$2,923.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,288.60
|
| Rate for Payer: Humana ChoiceCare |
$950.04
|
| Rate for Payer: Multiplan All |
$3,325.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,192.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,557.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,288.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,471.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,740.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,215.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$913.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,398.22
|
| Rate for Payer: Zelis Auto |
$1,461.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,827.00
|
|
