|
IMPLT INSERT TIBIAL SIZE6 9MM
|
Facility
|
IP
|
$3,806.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003292
|
|
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 TIBIAL STABILIZER #1 11MM
|
Facility
|
IP
|
$7,078.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003309
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,831.20 |
| Max. Negotiated Rate |
$6,724.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,662.40
|
| Rate for Payer: Cash Price |
$4,246.80
|
| Rate for Payer: Cash Price |
$4,246.80
|
| Rate for Payer: Cigna Commercial |
$6,016.30
|
| Rate for Payer: First Health Commercial |
$6,370.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,370.20
|
| Rate for Payer: GEHA Commercial |
$4,954.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,370.20
|
| Rate for Payer: Multiplan All |
$6,440.98
|
| Rate for Payer: OMNI Networks Commercial |
$4,954.60
|
| Rate for Payer: One Health Plan PPO/POS |
$6,370.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,724.10
|
| Rate for Payer: Three Rivers Provider Network All |
$5,308.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,582.54
|
| Rate for Payer: Zelis Auto |
$2,831.20
|
|
|
IMPLT INSERT TIBIAL STABILIZER #1 11MM
|
Facility
|
OP
|
$7,078.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003309
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,769.50 |
| Max. Negotiated Rate |
$6,724.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,246.80
|
| Rate for Payer: Cash Price |
$4,246.80
|
| Rate for Payer: Cash Price |
$4,246.80
|
| Rate for Payer: Cigna Commercial |
$6,016.30
|
| Rate for Payer: First Health Commercial |
$6,370.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,370.20
|
| Rate for Payer: GEHA Commercial |
$5,662.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,370.20
|
| Rate for Payer: Humana ChoiceCare |
$1,840.28
|
| Rate for Payer: Multiplan All |
$6,440.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,246.80
|
| Rate for Payer: OMNI Networks Commercial |
$4,954.60
|
| Rate for Payer: One Health Plan PPO/POS |
$6,370.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,724.10
|
| Rate for Payer: Three Rivers Provider Network All |
$5,308.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,228.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,769.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,582.54
|
| Rate for Payer: Zelis Auto |
$2,831.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,539.00
|
|
|
IMPLT INSERT TIBIAL STABILIZER #2
|
Facility
|
IP
|
$6,836.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002943
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,734.40 |
| Max. Negotiated Rate |
$6,494.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,468.80
|
| Rate for Payer: Cash Price |
$4,101.60
|
| Rate for Payer: Cash Price |
$4,101.60
|
| Rate for Payer: Cigna Commercial |
$5,810.60
|
| Rate for Payer: First Health Commercial |
$6,152.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,152.40
|
| Rate for Payer: GEHA Commercial |
$4,785.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,152.40
|
| Rate for Payer: Multiplan All |
$6,220.76
|
| Rate for Payer: OMNI Networks Commercial |
$4,785.20
|
| Rate for Payer: One Health Plan PPO/POS |
$6,152.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,494.20
|
| Rate for Payer: Three Rivers Provider Network All |
$5,127.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,357.48
|
| Rate for Payer: Zelis Auto |
$2,734.40
|
|
|
IMPLT INSERT TIBIAL STABILIZER #2
|
Facility
|
OP
|
$6,836.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002943
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,709.00 |
| Max. Negotiated Rate |
$6,494.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,101.60
|
| Rate for Payer: Cash Price |
$4,101.60
|
| Rate for Payer: Cash Price |
$4,101.60
|
| Rate for Payer: Cigna Commercial |
$5,810.60
|
| Rate for Payer: First Health Commercial |
$6,152.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,152.40
|
| Rate for Payer: GEHA Commercial |
$5,468.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,152.40
|
| Rate for Payer: Humana ChoiceCare |
$1,777.36
|
| Rate for Payer: Multiplan All |
$6,220.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,101.60
|
| Rate for Payer: OMNI Networks Commercial |
$4,785.20
|
| Rate for Payer: One Health Plan PPO/POS |
$6,152.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,494.20
|
| Rate for Payer: Three Rivers Provider Network All |
$5,127.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,015.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,709.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,357.48
|
| Rate for Payer: Zelis Auto |
$2,734.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,418.00
|
|
|
IMPLT INSERT TIBIAL STABILIZER #4
|
Facility
|
IP
|
$6,836.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003133
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,734.40 |
| Max. Negotiated Rate |
$6,494.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,468.80
|
| Rate for Payer: Cash Price |
$4,101.60
|
| Rate for Payer: Cash Price |
$4,101.60
|
| Rate for Payer: Cigna Commercial |
$5,810.60
|
| Rate for Payer: First Health Commercial |
$6,152.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,152.40
|
| Rate for Payer: GEHA Commercial |
$4,785.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,152.40
|
| Rate for Payer: Multiplan All |
$6,220.76
|
| Rate for Payer: OMNI Networks Commercial |
$4,785.20
|
| Rate for Payer: One Health Plan PPO/POS |
$6,152.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,494.20
|
| Rate for Payer: Three Rivers Provider Network All |
$5,127.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,357.48
|
| Rate for Payer: Zelis Auto |
$2,734.40
|
|
|
IMPLT INSERT TIBIAL STABILIZER #4
|
Facility
|
OP
|
$6,836.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003133
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,709.00 |
| Max. Negotiated Rate |
$6,494.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,101.60
|
| Rate for Payer: Cash Price |
$4,101.60
|
| Rate for Payer: Cash Price |
$4,101.60
|
| Rate for Payer: Cigna Commercial |
$5,810.60
|
| Rate for Payer: First Health Commercial |
$6,152.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,152.40
|
| Rate for Payer: GEHA Commercial |
$5,468.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,152.40
|
| Rate for Payer: Humana ChoiceCare |
$1,777.36
|
| Rate for Payer: Multiplan All |
$6,220.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,101.60
|
| Rate for Payer: OMNI Networks Commercial |
$4,785.20
|
| Rate for Payer: One Health Plan PPO/POS |
$6,152.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,494.20
|
| Rate for Payer: Three Rivers Provider Network All |
$5,127.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,015.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,709.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,357.48
|
| Rate for Payer: Zelis Auto |
$2,734.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,418.00
|
|
|
IMPLT INSERT TIBIAL STABILIZER #4 13MM
|
Facility
|
IP
|
$7,502.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,000.80 |
| Max. Negotiated Rate |
$7,126.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,001.60
|
| Rate for Payer: Cash Price |
$4,501.20
|
| Rate for Payer: Cash Price |
$4,501.20
|
| Rate for Payer: Cigna Commercial |
$6,376.70
|
| Rate for Payer: First Health Commercial |
$6,751.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,751.80
|
| Rate for Payer: GEHA Commercial |
$5,251.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,751.80
|
| Rate for Payer: Multiplan All |
$6,826.82
|
| Rate for Payer: OMNI Networks Commercial |
$5,251.40
|
| Rate for Payer: One Health Plan PPO/POS |
$6,751.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,126.90
|
| Rate for Payer: Three Rivers Provider Network All |
$5,626.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,976.86
|
| Rate for Payer: Zelis Auto |
$3,000.80
|
|
|
IMPLT INSERT TIBIAL STABILIZER #4 13MM
|
Facility
|
OP
|
$7,502.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,875.50 |
| Max. Negotiated Rate |
$7,126.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,501.20
|
| Rate for Payer: Cash Price |
$4,501.20
|
| Rate for Payer: Cash Price |
$4,501.20
|
| Rate for Payer: Cigna Commercial |
$6,376.70
|
| Rate for Payer: First Health Commercial |
$6,751.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,751.80
|
| Rate for Payer: GEHA Commercial |
$6,001.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,751.80
|
| Rate for Payer: Humana ChoiceCare |
$1,950.52
|
| Rate for Payer: Multiplan All |
$6,826.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,501.20
|
| Rate for Payer: OMNI Networks Commercial |
$5,251.40
|
| Rate for Payer: One Health Plan PPO/POS |
$6,751.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,126.90
|
| Rate for Payer: Three Rivers Provider Network All |
$5,626.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,601.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,875.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,976.86
|
| Rate for Payer: Zelis Auto |
$3,000.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,751.00
|
|
|
IMPLT INSERT TIBIAL STABILIZER SIZE 2
|
Facility
|
IP
|
$7,502.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006712
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,000.80 |
| Max. Negotiated Rate |
$7,126.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,001.60
|
| Rate for Payer: Cash Price |
$4,501.20
|
| Rate for Payer: Cash Price |
$4,501.20
|
| Rate for Payer: Cigna Commercial |
$6,376.70
|
| Rate for Payer: First Health Commercial |
$6,751.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,751.80
|
| Rate for Payer: GEHA Commercial |
$5,251.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,751.80
|
| Rate for Payer: Multiplan All |
$6,826.82
|
| Rate for Payer: OMNI Networks Commercial |
$5,251.40
|
| Rate for Payer: One Health Plan PPO/POS |
$6,751.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,126.90
|
| Rate for Payer: Three Rivers Provider Network All |
$5,626.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,976.86
|
| Rate for Payer: Zelis Auto |
$3,000.80
|
|
|
IMPLT INSERT TIBIAL STABILIZER SIZE 2
|
Facility
|
OP
|
$7,502.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006712
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,875.50 |
| Max. Negotiated Rate |
$7,126.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,501.20
|
| Rate for Payer: Cash Price |
$4,501.20
|
| Rate for Payer: Cash Price |
$4,501.20
|
| Rate for Payer: Cigna Commercial |
$6,376.70
|
| Rate for Payer: First Health Commercial |
$6,751.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,751.80
|
| Rate for Payer: GEHA Commercial |
$6,001.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,751.80
|
| Rate for Payer: Humana ChoiceCare |
$1,950.52
|
| Rate for Payer: Multiplan All |
$6,826.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,501.20
|
| Rate for Payer: OMNI Networks Commercial |
$5,251.40
|
| Rate for Payer: One Health Plan PPO/POS |
$6,751.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,126.90
|
| Rate for Payer: Three Rivers Provider Network All |
$5,626.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,601.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,875.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,976.86
|
| Rate for Payer: Zelis Auto |
$3,000.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,751.00
|
|
|
IMPLT INSERT TIBIAL STABILIZER SIZE 4
|
Facility
|
OP
|
$7,502.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002066
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,875.50 |
| Max. Negotiated Rate |
$7,126.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,501.20
|
| Rate for Payer: Cash Price |
$4,501.20
|
| Rate for Payer: Cash Price |
$4,501.20
|
| Rate for Payer: Cigna Commercial |
$6,376.70
|
| Rate for Payer: First Health Commercial |
$6,751.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,751.80
|
| Rate for Payer: GEHA Commercial |
$6,001.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,751.80
|
| Rate for Payer: Humana ChoiceCare |
$1,950.52
|
| Rate for Payer: Multiplan All |
$6,826.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,501.20
|
| Rate for Payer: OMNI Networks Commercial |
$5,251.40
|
| Rate for Payer: One Health Plan PPO/POS |
$6,751.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,126.90
|
| Rate for Payer: Three Rivers Provider Network All |
$5,626.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,601.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,875.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,976.86
|
| Rate for Payer: Zelis Auto |
$3,000.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,751.00
|
|
|
IMPLT INSERT TIBIAL STABILIZER SIZE 4
|
Facility
|
OP
|
$6,701.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,675.25 |
| Max. Negotiated Rate |
$6,365.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,020.60
|
| Rate for Payer: Cash Price |
$4,020.60
|
| Rate for Payer: Cash Price |
$4,020.60
|
| Rate for Payer: Cigna Commercial |
$5,695.85
|
| Rate for Payer: First Health Commercial |
$6,030.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,030.90
|
| Rate for Payer: GEHA Commercial |
$5,360.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,030.90
|
| Rate for Payer: Humana ChoiceCare |
$1,742.26
|
| Rate for Payer: Multiplan All |
$6,097.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,020.60
|
| Rate for Payer: OMNI Networks Commercial |
$4,690.70
|
| Rate for Payer: One Health Plan PPO/POS |
$6,030.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,365.95
|
| Rate for Payer: Three Rivers Provider Network All |
$5,025.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,896.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,675.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,231.93
|
| Rate for Payer: Zelis Auto |
$2,680.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,350.50
|
|
|
IMPLT INSERT TIBIAL STABILIZER SIZE 4
|
Facility
|
IP
|
$6,701.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,680.40 |
| Max. Negotiated Rate |
$6,365.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,360.80
|
| Rate for Payer: Cash Price |
$4,020.60
|
| Rate for Payer: Cash Price |
$4,020.60
|
| Rate for Payer: Cigna Commercial |
$5,695.85
|
| Rate for Payer: First Health Commercial |
$6,030.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,030.90
|
| Rate for Payer: GEHA Commercial |
$4,690.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,030.90
|
| Rate for Payer: Multiplan All |
$6,097.91
|
| Rate for Payer: OMNI Networks Commercial |
$4,690.70
|
| Rate for Payer: One Health Plan PPO/POS |
$6,030.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,365.95
|
| Rate for Payer: Three Rivers Provider Network All |
$5,025.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,231.93
|
| Rate for Payer: Zelis Auto |
$2,680.40
|
|
|
IMPLT INSERT TIBIAL STABILIZER SIZE 4
|
Facility
|
IP
|
$7,502.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002066
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,000.80 |
| Max. Negotiated Rate |
$7,126.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,001.60
|
| Rate for Payer: Cash Price |
$4,501.20
|
| Rate for Payer: Cash Price |
$4,501.20
|
| Rate for Payer: Cigna Commercial |
$6,376.70
|
| Rate for Payer: First Health Commercial |
$6,751.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,751.80
|
| Rate for Payer: GEHA Commercial |
$5,251.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,751.80
|
| Rate for Payer: Multiplan All |
$6,826.82
|
| Rate for Payer: OMNI Networks Commercial |
$5,251.40
|
| Rate for Payer: One Health Plan PPO/POS |
$6,751.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,126.90
|
| Rate for Payer: Three Rivers Provider Network All |
$5,626.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,976.86
|
| Rate for Payer: Zelis Auto |
$3,000.80
|
|
|
IMPLT INSERT TIBIAL STABILIZER SIZE 6
|
Facility
|
IP
|
$8,327.55
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003498
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,331.02 |
| Max. Negotiated Rate |
$7,911.17 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,662.04
|
| Rate for Payer: Cash Price |
$4,996.53
|
| Rate for Payer: Cash Price |
$4,996.53
|
| Rate for Payer: Cigna Commercial |
$7,078.42
|
| Rate for Payer: First Health Commercial |
$7,494.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,494.80
|
| Rate for Payer: GEHA Commercial |
$5,829.28
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,494.80
|
| Rate for Payer: Multiplan All |
$7,578.07
|
| Rate for Payer: OMNI Networks Commercial |
$5,829.28
|
| Rate for Payer: One Health Plan PPO/POS |
$7,494.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,911.17
|
| Rate for Payer: Three Rivers Provider Network All |
$6,245.66
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,744.62
|
| Rate for Payer: Zelis Auto |
$3,331.02
|
|
|
IMPLT INSERT TIBIAL STABILIZER SIZE 6
|
Facility
|
OP
|
$3,755.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002676
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$938.75 |
| Max. Negotiated Rate |
$3,567.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,253.00
|
| Rate for Payer: Cash Price |
$2,253.00
|
| Rate for Payer: Cash Price |
$2,253.00
|
| Rate for Payer: Cigna Commercial |
$3,191.75
|
| Rate for Payer: First Health Commercial |
$3,379.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,379.50
|
| Rate for Payer: GEHA Commercial |
$3,004.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,379.50
|
| Rate for Payer: Humana ChoiceCare |
$976.30
|
| Rate for Payer: Multiplan All |
$3,417.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,253.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,628.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,379.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,567.25
|
| Rate for Payer: Three Rivers Provider Network All |
$2,816.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,304.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$938.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,492.15
|
| Rate for Payer: Zelis Auto |
$1,502.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,877.50
|
|
|
IMPLT INSERT TIBIAL STABILIZER SIZE 6
|
Facility
|
IP
|
$3,755.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002676
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,502.00 |
| Max. Negotiated Rate |
$3,567.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,004.00
|
| Rate for Payer: Cash Price |
$2,253.00
|
| Rate for Payer: Cash Price |
$2,253.00
|
| Rate for Payer: Cigna Commercial |
$3,191.75
|
| Rate for Payer: First Health Commercial |
$3,379.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,379.50
|
| Rate for Payer: GEHA Commercial |
$2,628.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,379.50
|
| Rate for Payer: Multiplan All |
$3,417.05
|
| Rate for Payer: OMNI Networks Commercial |
$2,628.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,379.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,567.25
|
| Rate for Payer: Three Rivers Provider Network All |
$2,816.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,492.15
|
| Rate for Payer: Zelis Auto |
$1,502.00
|
|
|
IMPLT INSERT TIBIAL STABILIZER SIZE 6
|
Facility
|
OP
|
$8,327.55
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003498
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,081.89 |
| Max. Negotiated Rate |
$7,911.17 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,996.53
|
| Rate for Payer: Cash Price |
$4,996.53
|
| Rate for Payer: Cash Price |
$4,996.53
|
| Rate for Payer: Cigna Commercial |
$7,078.42
|
| Rate for Payer: First Health Commercial |
$7,494.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,494.80
|
| Rate for Payer: GEHA Commercial |
$6,662.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,494.80
|
| Rate for Payer: Humana ChoiceCare |
$2,165.16
|
| Rate for Payer: Multiplan All |
$7,578.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,996.53
|
| Rate for Payer: OMNI Networks Commercial |
$5,829.28
|
| Rate for Payer: One Health Plan PPO/POS |
$7,494.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,911.17
|
| Rate for Payer: Three Rivers Provider Network All |
$6,245.66
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,328.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,081.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,744.62
|
| Rate for Payer: Zelis Auto |
$3,331.02
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,163.77
|
|
|
IMPLT INSERT TIBIAL STABILIZER TOT #7 9M
|
Facility
|
OP
|
$7,078.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003240
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,769.50 |
| Max. Negotiated Rate |
$6,724.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,246.80
|
| Rate for Payer: Cash Price |
$4,246.80
|
| Rate for Payer: Cash Price |
$4,246.80
|
| Rate for Payer: Cigna Commercial |
$6,016.30
|
| Rate for Payer: First Health Commercial |
$6,370.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,370.20
|
| Rate for Payer: GEHA Commercial |
$5,662.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,370.20
|
| Rate for Payer: Humana ChoiceCare |
$1,840.28
|
| Rate for Payer: Multiplan All |
$6,440.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,246.80
|
| Rate for Payer: OMNI Networks Commercial |
$4,954.60
|
| Rate for Payer: One Health Plan PPO/POS |
$6,370.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,724.10
|
| Rate for Payer: Three Rivers Provider Network All |
$5,308.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,228.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,769.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,582.54
|
| Rate for Payer: Zelis Auto |
$2,831.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,539.00
|
|
|
IMPLT INSERT TIBIAL STABILIZER TOT #7 9M
|
Facility
|
IP
|
$7,078.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003240
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,831.20 |
| Max. Negotiated Rate |
$6,724.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,662.40
|
| Rate for Payer: Cash Price |
$4,246.80
|
| Rate for Payer: Cash Price |
$4,246.80
|
| Rate for Payer: Cigna Commercial |
$6,016.30
|
| Rate for Payer: First Health Commercial |
$6,370.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,370.20
|
| Rate for Payer: GEHA Commercial |
$4,954.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,370.20
|
| Rate for Payer: Multiplan All |
$6,440.98
|
| Rate for Payer: OMNI Networks Commercial |
$4,954.60
|
| Rate for Payer: One Health Plan PPO/POS |
$6,370.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,724.10
|
| Rate for Payer: Three Rivers Provider Network All |
$5,308.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,582.54
|
| Rate for Payer: Zelis Auto |
$2,831.20
|
|
|
IMPLT INSERT TIBIAL STABILIZER TOTAL #7
|
Facility
|
OP
|
$7,078.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003102
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,769.50 |
| Max. Negotiated Rate |
$6,724.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,246.80
|
| Rate for Payer: Cash Price |
$4,246.80
|
| Rate for Payer: Cash Price |
$4,246.80
|
| Rate for Payer: Cigna Commercial |
$6,016.30
|
| Rate for Payer: First Health Commercial |
$6,370.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,370.20
|
| Rate for Payer: GEHA Commercial |
$5,662.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,370.20
|
| Rate for Payer: Humana ChoiceCare |
$1,840.28
|
| Rate for Payer: Multiplan All |
$6,440.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,246.80
|
| Rate for Payer: OMNI Networks Commercial |
$4,954.60
|
| Rate for Payer: One Health Plan PPO/POS |
$6,370.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,724.10
|
| Rate for Payer: Three Rivers Provider Network All |
$5,308.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,228.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,769.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,582.54
|
| Rate for Payer: Zelis Auto |
$2,831.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,539.00
|
|
|
IMPLT INSERT TIBIAL STABILIZER TOTAL #7
|
Facility
|
IP
|
$7,078.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003102
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,831.20 |
| Max. Negotiated Rate |
$6,724.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,662.40
|
| Rate for Payer: Cash Price |
$4,246.80
|
| Rate for Payer: Cash Price |
$4,246.80
|
| Rate for Payer: Cigna Commercial |
$6,016.30
|
| Rate for Payer: First Health Commercial |
$6,370.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,370.20
|
| Rate for Payer: GEHA Commercial |
$4,954.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,370.20
|
| Rate for Payer: Multiplan All |
$6,440.98
|
| Rate for Payer: OMNI Networks Commercial |
$4,954.60
|
| Rate for Payer: One Health Plan PPO/POS |
$6,370.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,724.10
|
| Rate for Payer: Three Rivers Provider Network All |
$5,308.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,582.54
|
| Rate for Payer: Zelis Auto |
$2,831.20
|
|
|
IMPLT INSERT TIBIAL STABILIZER TOTAL #8
|
Facility
|
IP
|
$6,849.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002642
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,739.60 |
| Max. Negotiated Rate |
$6,506.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,479.20
|
| Rate for Payer: Cash Price |
$4,109.40
|
| Rate for Payer: Cash Price |
$4,109.40
|
| Rate for Payer: Cigna Commercial |
$5,821.65
|
| Rate for Payer: First Health Commercial |
$6,164.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,164.10
|
| Rate for Payer: GEHA Commercial |
$4,794.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,164.10
|
| Rate for Payer: Multiplan All |
$6,232.59
|
| Rate for Payer: OMNI Networks Commercial |
$4,794.30
|
| Rate for Payer: One Health Plan PPO/POS |
$6,164.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,506.55
|
| Rate for Payer: Three Rivers Provider Network All |
$5,136.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,369.57
|
| Rate for Payer: Zelis Auto |
$2,739.60
|
|
|
IMPLT INSERT TIBIAL STABILIZER TOTAL #8
|
Facility
|
OP
|
$6,849.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002642
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,712.25 |
| Max. Negotiated Rate |
$6,506.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,109.40
|
| Rate for Payer: Cash Price |
$4,109.40
|
| Rate for Payer: Cash Price |
$4,109.40
|
| Rate for Payer: Cigna Commercial |
$5,821.65
|
| Rate for Payer: First Health Commercial |
$6,164.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,164.10
|
| Rate for Payer: GEHA Commercial |
$5,479.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,164.10
|
| Rate for Payer: Humana ChoiceCare |
$1,780.74
|
| Rate for Payer: Multiplan All |
$6,232.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,109.40
|
| Rate for Payer: OMNI Networks Commercial |
$4,794.30
|
| Rate for Payer: One Health Plan PPO/POS |
$6,164.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,506.55
|
| Rate for Payer: Three Rivers Provider Network All |
$5,136.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,027.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,712.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,369.57
|
| Rate for Payer: Zelis Auto |
$2,739.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,424.50
|
|
