|
IMPLT INSERT HUMERAL X3 REUNION 40X4MM
|
Facility
|
OP
|
$6,242.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006680
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,560.50 |
| Max. Negotiated Rate |
$5,929.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,745.20
|
| Rate for Payer: Cash Price |
$3,745.20
|
| Rate for Payer: Cash Price |
$3,745.20
|
| Rate for Payer: Cigna Commercial |
$5,305.70
|
| Rate for Payer: First Health Commercial |
$5,617.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,617.80
|
| Rate for Payer: GEHA Commercial |
$4,993.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,617.80
|
| Rate for Payer: Humana ChoiceCare |
$1,622.92
|
| Rate for Payer: Multiplan All |
$5,680.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,745.20
|
| Rate for Payer: OMNI Networks Commercial |
$4,369.40
|
| Rate for Payer: One Health Plan PPO/POS |
$5,617.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,929.90
|
| Rate for Payer: Three Rivers Provider Network All |
$4,681.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,492.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,560.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,805.06
|
| Rate for Payer: Zelis Auto |
$2,496.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,121.00
|
|
|
IMPLT INSERT HUMERAL X3 REUNION 40X8MM
|
Facility
|
IP
|
$6,242.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006671
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,496.80 |
| Max. Negotiated Rate |
$5,929.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,993.60
|
| Rate for Payer: Cash Price |
$3,745.20
|
| Rate for Payer: Cash Price |
$3,745.20
|
| Rate for Payer: Cigna Commercial |
$5,305.70
|
| Rate for Payer: First Health Commercial |
$5,617.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,617.80
|
| Rate for Payer: GEHA Commercial |
$4,369.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,617.80
|
| Rate for Payer: Multiplan All |
$5,680.22
|
| Rate for Payer: OMNI Networks Commercial |
$4,369.40
|
| Rate for Payer: One Health Plan PPO/POS |
$5,617.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,929.90
|
| Rate for Payer: Three Rivers Provider Network All |
$4,681.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,805.06
|
| Rate for Payer: Zelis Auto |
$2,496.80
|
|
|
IMPLT INSERT HUMERAL X3 REUNION 40X8MM
|
Facility
|
OP
|
$6,242.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006671
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,560.50 |
| Max. Negotiated Rate |
$5,929.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,745.20
|
| Rate for Payer: Cash Price |
$3,745.20
|
| Rate for Payer: Cash Price |
$3,745.20
|
| Rate for Payer: Cigna Commercial |
$5,305.70
|
| Rate for Payer: First Health Commercial |
$5,617.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,617.80
|
| Rate for Payer: GEHA Commercial |
$4,993.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,617.80
|
| Rate for Payer: Humana ChoiceCare |
$1,622.92
|
| Rate for Payer: Multiplan All |
$5,680.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,745.20
|
| Rate for Payer: OMNI Networks Commercial |
$4,369.40
|
| Rate for Payer: One Health Plan PPO/POS |
$5,617.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,929.90
|
| Rate for Payer: Three Rivers Provider Network All |
$4,681.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,492.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,560.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,805.06
|
| Rate for Payer: Zelis Auto |
$2,496.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,121.00
|
|
|
IMPLT INSERT LINER MDM SIZE 38D
|
Facility
|
IP
|
$3,578.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002075
|
|
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 LINER MDM SIZE 38D
|
Facility
|
OP
|
$3,578.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002075
|
|
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 LOCKING
|
Facility
|
IP
|
$604.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006515
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.60 |
| Max. Negotiated Rate |
$573.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$483.20
|
| Rate for Payer: Cash Price |
$362.40
|
| Rate for Payer: Cash Price |
$362.40
|
| Rate for Payer: Cigna Commercial |
$513.40
|
| Rate for Payer: First Health Commercial |
$543.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$543.60
|
| Rate for Payer: GEHA Commercial |
$422.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$543.60
|
| Rate for Payer: Multiplan All |
$549.64
|
| Rate for Payer: OMNI Networks Commercial |
$422.80
|
| Rate for Payer: One Health Plan PPO/POS |
$543.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$573.80
|
| Rate for Payer: Three Rivers Provider Network All |
$453.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$561.72
|
| Rate for Payer: Zelis Auto |
$241.60
|
|
|
IMPLT INSERT LOCKING
|
Facility
|
OP
|
$604.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006515
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$151.00 |
| Max. Negotiated Rate |
$573.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$362.40
|
| Rate for Payer: Cash Price |
$362.40
|
| Rate for Payer: Cash Price |
$362.40
|
| Rate for Payer: Cigna Commercial |
$513.40
|
| Rate for Payer: First Health Commercial |
$543.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$543.60
|
| Rate for Payer: GEHA Commercial |
$483.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$543.60
|
| Rate for Payer: Humana ChoiceCare |
$157.04
|
| Rate for Payer: Multiplan All |
$549.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$362.40
|
| Rate for Payer: OMNI Networks Commercial |
$422.80
|
| Rate for Payer: One Health Plan PPO/POS |
$543.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$573.80
|
| Rate for Payer: Three Rivers Provider Network All |
$453.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$531.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$151.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$561.72
|
| Rate for Payer: Zelis Auto |
$241.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$302.00
|
|
|
IMPLT INSERT OFFSET 5MM LOCKING
|
Facility
|
IP
|
$1,175.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006530
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$470.00 |
| Max. Negotiated Rate |
$1,116.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$940.00
|
| Rate for Payer: Cash Price |
$705.00
|
| Rate for Payer: Cash Price |
$705.00
|
| Rate for Payer: Cigna Commercial |
$998.75
|
| Rate for Payer: First Health Commercial |
$1,057.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,057.50
|
| Rate for Payer: GEHA Commercial |
$822.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,057.50
|
| Rate for Payer: Multiplan All |
$1,069.25
|
| Rate for Payer: OMNI Networks Commercial |
$822.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,057.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,116.25
|
| Rate for Payer: Three Rivers Provider Network All |
$881.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,092.75
|
| Rate for Payer: Zelis Auto |
$470.00
|
|
|
IMPLT INSERT OFFSET 5MM LOCKING
|
Facility
|
OP
|
$1,175.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006530
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$293.75 |
| Max. Negotiated Rate |
$1,116.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$705.00
|
| Rate for Payer: Cash Price |
$705.00
|
| Rate for Payer: Cash Price |
$705.00
|
| Rate for Payer: Cigna Commercial |
$998.75
|
| Rate for Payer: First Health Commercial |
$1,057.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,057.50
|
| Rate for Payer: GEHA Commercial |
$940.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,057.50
|
| Rate for Payer: Humana ChoiceCare |
$305.50
|
| Rate for Payer: Multiplan All |
$1,069.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$705.00
|
| Rate for Payer: OMNI Networks Commercial |
$822.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,057.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,116.25
|
| Rate for Payer: Three Rivers Provider Network All |
$881.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,034.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$293.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,092.75
|
| Rate for Payer: Zelis Auto |
$470.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$587.50
|
|
|
IMPLT INSERT ONLAY TIBIAL 6X8MM
|
Facility
|
IP
|
$3,806.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002044
|
|
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 INSERT ONLAY TIBIAL 6X8MM
|
Facility
|
OP
|
$3,806.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002044
|
|
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 INSERT POLYETHYLENE 0 DEG 28MM A
|
Facility
|
OP
|
$3,237.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003490
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$809.25 |
| Max. Negotiated Rate |
$3,075.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,942.20
|
| Rate for Payer: Cash Price |
$1,942.20
|
| Rate for Payer: Cash Price |
$1,942.20
|
| Rate for Payer: Cigna Commercial |
$2,751.45
|
| Rate for Payer: First Health Commercial |
$2,913.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,913.30
|
| Rate for Payer: GEHA Commercial |
$2,589.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,913.30
|
| Rate for Payer: Humana ChoiceCare |
$841.62
|
| Rate for Payer: Multiplan All |
$2,945.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,942.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,265.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,913.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,075.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,427.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,848.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$809.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,010.41
|
| Rate for Payer: Zelis Auto |
$1,294.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,618.50
|
|
|
IMPLT INSERT POLYETHYLENE 0 DEG 28MM A
|
Facility
|
IP
|
$3,237.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003490
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,294.80 |
| Max. Negotiated Rate |
$3,075.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,589.60
|
| Rate for Payer: Cash Price |
$1,942.20
|
| Rate for Payer: Cash Price |
$1,942.20
|
| Rate for Payer: Cigna Commercial |
$2,751.45
|
| Rate for Payer: First Health Commercial |
$2,913.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,913.30
|
| Rate for Payer: GEHA Commercial |
$2,265.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,913.30
|
| Rate for Payer: Multiplan All |
$2,945.67
|
| Rate for Payer: OMNI Networks Commercial |
$2,265.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,913.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,075.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,427.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,010.41
|
| Rate for Payer: Zelis Auto |
$1,294.80
|
|
|
IMPLT INSERT POLYETHYLENE 0 DEG 32MM B
|
Facility
|
IP
|
$3,237.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003499
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,294.80 |
| Max. Negotiated Rate |
$3,075.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,589.60
|
| Rate for Payer: Cash Price |
$1,942.20
|
| Rate for Payer: Cash Price |
$1,942.20
|
| Rate for Payer: Cigna Commercial |
$2,751.45
|
| Rate for Payer: First Health Commercial |
$2,913.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,913.30
|
| Rate for Payer: GEHA Commercial |
$2,265.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,913.30
|
| Rate for Payer: Multiplan All |
$2,945.67
|
| Rate for Payer: OMNI Networks Commercial |
$2,265.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,913.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,075.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,427.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,010.41
|
| Rate for Payer: Zelis Auto |
$1,294.80
|
|
|
IMPLT INSERT POLYETHYLENE 0 DEG 32MM B
|
Facility
|
OP
|
$3,237.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003499
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$809.25 |
| Max. Negotiated Rate |
$3,075.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,942.20
|
| Rate for Payer: Cash Price |
$1,942.20
|
| Rate for Payer: Cash Price |
$1,942.20
|
| Rate for Payer: Cigna Commercial |
$2,751.45
|
| Rate for Payer: First Health Commercial |
$2,913.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,913.30
|
| Rate for Payer: GEHA Commercial |
$2,589.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,913.30
|
| Rate for Payer: Humana ChoiceCare |
$841.62
|
| Rate for Payer: Multiplan All |
$2,945.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,942.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,265.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,913.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,075.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,427.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,848.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$809.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,010.41
|
| Rate for Payer: Zelis Auto |
$1,294.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,618.50
|
|
|
IMPLT INSERT POLYETHYLENE 10 DEG 32MM E
|
Facility
|
OP
|
$3,237.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003392
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$809.25 |
| Max. Negotiated Rate |
$3,075.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,942.20
|
| Rate for Payer: Cash Price |
$1,942.20
|
| Rate for Payer: Cash Price |
$1,942.20
|
| Rate for Payer: Cigna Commercial |
$2,751.45
|
| Rate for Payer: First Health Commercial |
$2,913.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,913.30
|
| Rate for Payer: GEHA Commercial |
$2,589.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,913.30
|
| Rate for Payer: Humana ChoiceCare |
$841.62
|
| Rate for Payer: Multiplan All |
$2,945.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,942.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,265.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,913.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,075.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,427.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,848.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$809.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,010.41
|
| Rate for Payer: Zelis Auto |
$1,294.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,618.50
|
|
|
IMPLT INSERT POLYETHYLENE 10 DEG 32MM E
|
Facility
|
IP
|
$3,237.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003392
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,294.80 |
| Max. Negotiated Rate |
$3,075.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,589.60
|
| Rate for Payer: Cash Price |
$1,942.20
|
| Rate for Payer: Cash Price |
$1,942.20
|
| Rate for Payer: Cigna Commercial |
$2,751.45
|
| Rate for Payer: First Health Commercial |
$2,913.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,913.30
|
| Rate for Payer: GEHA Commercial |
$2,265.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,913.30
|
| Rate for Payer: Multiplan All |
$2,945.67
|
| Rate for Payer: OMNI Networks Commercial |
$2,265.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,913.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,075.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,427.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,010.41
|
| Rate for Payer: Zelis Auto |
$1,294.80
|
|
|
IMPLT INSERT POLYETHYLENE 10 DEG 36MM E
|
Facility
|
IP
|
$3,237.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003388
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,294.80 |
| Max. Negotiated Rate |
$3,075.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,589.60
|
| Rate for Payer: Cash Price |
$1,942.20
|
| Rate for Payer: Cash Price |
$1,942.20
|
| Rate for Payer: Cigna Commercial |
$2,751.45
|
| Rate for Payer: First Health Commercial |
$2,913.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,913.30
|
| Rate for Payer: GEHA Commercial |
$2,265.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,913.30
|
| Rate for Payer: Multiplan All |
$2,945.67
|
| Rate for Payer: OMNI Networks Commercial |
$2,265.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,913.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,075.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,427.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,010.41
|
| Rate for Payer: Zelis Auto |
$1,294.80
|
|
|
IMPLT INSERT POLYETHYLENE 10 DEG 36MM E
|
Facility
|
OP
|
$3,237.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003388
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$809.25 |
| Max. Negotiated Rate |
$3,075.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,942.20
|
| Rate for Payer: Cash Price |
$1,942.20
|
| Rate for Payer: Cash Price |
$1,942.20
|
| Rate for Payer: Cigna Commercial |
$2,751.45
|
| Rate for Payer: First Health Commercial |
$2,913.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,913.30
|
| Rate for Payer: GEHA Commercial |
$2,589.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,913.30
|
| Rate for Payer: Humana ChoiceCare |
$841.62
|
| Rate for Payer: Multiplan All |
$2,945.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,942.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,265.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,913.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,075.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,427.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,848.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$809.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,010.41
|
| Rate for Payer: Zelis Auto |
$1,294.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,618.50
|
|
|
IMPLT INSERT POLYETHYLENE 10 DEG 36MM F
|
Facility
|
IP
|
$3,237.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003393
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,294.80 |
| Max. Negotiated Rate |
$3,075.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,589.60
|
| Rate for Payer: Cash Price |
$1,942.20
|
| Rate for Payer: Cash Price |
$1,942.20
|
| Rate for Payer: Cigna Commercial |
$2,751.45
|
| Rate for Payer: First Health Commercial |
$2,913.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,913.30
|
| Rate for Payer: GEHA Commercial |
$2,265.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,913.30
|
| Rate for Payer: Multiplan All |
$2,945.67
|
| Rate for Payer: OMNI Networks Commercial |
$2,265.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,913.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,075.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,427.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,010.41
|
| Rate for Payer: Zelis Auto |
$1,294.80
|
|
|
IMPLT INSERT POLYETHYLENE 10 DEG 36MM F
|
Facility
|
OP
|
$3,237.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002034
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$809.25 |
| Max. Negotiated Rate |
$3,075.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,942.20
|
| Rate for Payer: Cash Price |
$1,942.20
|
| Rate for Payer: Cash Price |
$1,942.20
|
| Rate for Payer: Cigna Commercial |
$2,751.45
|
| Rate for Payer: First Health Commercial |
$2,913.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,913.30
|
| Rate for Payer: GEHA Commercial |
$2,589.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,913.30
|
| Rate for Payer: Humana ChoiceCare |
$841.62
|
| Rate for Payer: Multiplan All |
$2,945.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,942.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,265.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,913.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,075.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,427.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,848.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$809.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,010.41
|
| Rate for Payer: Zelis Auto |
$1,294.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,618.50
|
|
|
IMPLT INSERT POLYETHYLENE 10 DEG 36MM F
|
Facility
|
IP
|
$3,237.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002034
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,294.80 |
| Max. Negotiated Rate |
$3,075.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,589.60
|
| Rate for Payer: Cash Price |
$1,942.20
|
| Rate for Payer: Cash Price |
$1,942.20
|
| Rate for Payer: Cigna Commercial |
$2,751.45
|
| Rate for Payer: First Health Commercial |
$2,913.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,913.30
|
| Rate for Payer: GEHA Commercial |
$2,265.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,913.30
|
| Rate for Payer: Multiplan All |
$2,945.67
|
| Rate for Payer: OMNI Networks Commercial |
$2,265.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,913.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,075.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,427.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,010.41
|
| Rate for Payer: Zelis Auto |
$1,294.80
|
|
|
IMPLT INSERT POLYETHYLENE 10 DEG 36MM F
|
Facility
|
OP
|
$3,237.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003393
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$809.25 |
| Max. Negotiated Rate |
$3,075.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,942.20
|
| Rate for Payer: Cash Price |
$1,942.20
|
| Rate for Payer: Cash Price |
$1,942.20
|
| Rate for Payer: Cigna Commercial |
$2,751.45
|
| Rate for Payer: First Health Commercial |
$2,913.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,913.30
|
| Rate for Payer: GEHA Commercial |
$2,589.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,913.30
|
| Rate for Payer: Humana ChoiceCare |
$841.62
|
| Rate for Payer: Multiplan All |
$2,945.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,942.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,265.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,913.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,075.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,427.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,848.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$809.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,010.41
|
| Rate for Payer: Zelis Auto |
$1,294.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,618.50
|
|
|
IMPLT INSERT POLYETHYLENE 10 DEG 36MM G
|
Facility
|
IP
|
$3,237.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7007049
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,294.80 |
| Max. Negotiated Rate |
$3,075.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,589.60
|
| Rate for Payer: Cash Price |
$1,942.20
|
| Rate for Payer: Cash Price |
$1,942.20
|
| Rate for Payer: Cigna Commercial |
$2,751.45
|
| Rate for Payer: First Health Commercial |
$2,913.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,913.30
|
| Rate for Payer: GEHA Commercial |
$2,265.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,913.30
|
| Rate for Payer: Multiplan All |
$2,945.67
|
| Rate for Payer: OMNI Networks Commercial |
$2,265.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,913.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,075.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,427.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,010.41
|
| Rate for Payer: Zelis Auto |
$1,294.80
|
|
|
IMPLT INSERT POLYETHYLENE 10 DEG 36MM G
|
Facility
|
OP
|
$3,237.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7007049
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$809.25 |
| Max. Negotiated Rate |
$3,075.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,942.20
|
| Rate for Payer: Cash Price |
$1,942.20
|
| Rate for Payer: Cash Price |
$1,942.20
|
| Rate for Payer: Cigna Commercial |
$2,751.45
|
| Rate for Payer: First Health Commercial |
$2,913.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,913.30
|
| Rate for Payer: GEHA Commercial |
$2,589.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,913.30
|
| Rate for Payer: Humana ChoiceCare |
$841.62
|
| Rate for Payer: Multiplan All |
$2,945.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,942.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,265.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,913.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,075.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,427.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,848.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$809.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,010.41
|
| Rate for Payer: Zelis Auto |
$1,294.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,618.50
|
|
