|
IMPLT LINER ACETABULAR 36X52MM
|
Facility
|
IP
|
$1,776.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002250
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$710.40 |
| Max. Negotiated Rate |
$1,687.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,420.80
|
| Rate for Payer: Cash Price |
$1,065.60
|
| Rate for Payer: Cash Price |
$1,065.60
|
| Rate for Payer: Cigna Commercial |
$1,509.60
|
| Rate for Payer: First Health Commercial |
$1,598.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,598.40
|
| Rate for Payer: GEHA Commercial |
$1,243.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,598.40
|
| Rate for Payer: Multiplan All |
$1,616.16
|
| Rate for Payer: OMNI Networks Commercial |
$1,243.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,598.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,687.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,332.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,651.68
|
| Rate for Payer: Zelis Auto |
$710.40
|
|
|
IMPLT LINER ACETABULAR 62MM
|
Facility
|
OP
|
$1,776.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$444.00 |
| Max. Negotiated Rate |
$1,687.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,065.60
|
| Rate for Payer: Cash Price |
$1,065.60
|
| Rate for Payer: Cash Price |
$1,065.60
|
| Rate for Payer: Cigna Commercial |
$1,509.60
|
| Rate for Payer: First Health Commercial |
$1,598.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,598.40
|
| Rate for Payer: GEHA Commercial |
$1,420.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,598.40
|
| Rate for Payer: Humana ChoiceCare |
$461.76
|
| Rate for Payer: Multiplan All |
$1,616.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,065.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,243.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,598.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,687.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,332.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,562.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$444.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,651.68
|
| Rate for Payer: Zelis Auto |
$710.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$888.00
|
|
|
IMPLT LINER ACETABULAR 62MM
|
Facility
|
IP
|
$1,776.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$710.40 |
| Max. Negotiated Rate |
$1,687.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,420.80
|
| Rate for Payer: Cash Price |
$1,065.60
|
| Rate for Payer: Cash Price |
$1,065.60
|
| Rate for Payer: Cigna Commercial |
$1,509.60
|
| Rate for Payer: First Health Commercial |
$1,598.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,598.40
|
| Rate for Payer: GEHA Commercial |
$1,243.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,598.40
|
| Rate for Payer: Multiplan All |
$1,616.16
|
| Rate for Payer: OMNI Networks Commercial |
$1,243.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,598.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,687.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,332.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,651.68
|
| Rate for Payer: Zelis Auto |
$710.40
|
|
|
IMPLT LINER ACETABULAR POLY 28MM
|
Facility
|
OP
|
$8,791.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002572
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,197.75 |
| Max. Negotiated Rate |
$8,351.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,274.60
|
| Rate for Payer: Cash Price |
$5,274.60
|
| Rate for Payer: Cash Price |
$5,274.60
|
| Rate for Payer: Cigna Commercial |
$7,472.35
|
| Rate for Payer: First Health Commercial |
$7,911.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,911.90
|
| Rate for Payer: GEHA Commercial |
$7,032.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,911.90
|
| Rate for Payer: Humana ChoiceCare |
$2,285.66
|
| Rate for Payer: Multiplan All |
$7,999.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,274.60
|
| Rate for Payer: OMNI Networks Commercial |
$6,153.70
|
| Rate for Payer: One Health Plan PPO/POS |
$7,911.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,351.45
|
| Rate for Payer: Three Rivers Provider Network All |
$6,593.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,736.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,197.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,175.63
|
| Rate for Payer: Zelis Auto |
$3,516.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,395.50
|
|
|
IMPLT LINER ACETABULAR POLY 28MM
|
Facility
|
IP
|
$8,791.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002572
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,516.40 |
| Max. Negotiated Rate |
$8,351.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7,032.80
|
| Rate for Payer: Cash Price |
$5,274.60
|
| Rate for Payer: Cash Price |
$5,274.60
|
| Rate for Payer: Cigna Commercial |
$7,472.35
|
| Rate for Payer: First Health Commercial |
$7,911.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,911.90
|
| Rate for Payer: GEHA Commercial |
$6,153.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,911.90
|
| Rate for Payer: Multiplan All |
$7,999.81
|
| Rate for Payer: OMNI Networks Commercial |
$6,153.70
|
| Rate for Payer: One Health Plan PPO/POS |
$7,911.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,351.45
|
| Rate for Payer: Three Rivers Provider Network All |
$6,593.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,175.63
|
| Rate for Payer: Zelis Auto |
$3,516.40
|
|
|
IMPLT LINER ACETABULAR POLY 32MM 50MM
|
Facility
|
IP
|
$5,007.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003202
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,002.80 |
| Max. Negotiated Rate |
$4,756.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,005.60
|
| Rate for Payer: Cash Price |
$3,004.20
|
| Rate for Payer: Cash Price |
$3,004.20
|
| Rate for Payer: Cigna Commercial |
$4,255.95
|
| Rate for Payer: First Health Commercial |
$4,506.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,506.30
|
| Rate for Payer: GEHA Commercial |
$3,504.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,506.30
|
| Rate for Payer: Multiplan All |
$4,556.37
|
| Rate for Payer: OMNI Networks Commercial |
$3,504.90
|
| Rate for Payer: One Health Plan PPO/POS |
$4,506.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,756.65
|
| Rate for Payer: Three Rivers Provider Network All |
$3,755.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,656.51
|
| Rate for Payer: Zelis Auto |
$2,002.80
|
|
|
IMPLT LINER ACETABULAR POLY 32MM 50MM
|
Facility
|
OP
|
$5,007.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003202
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,251.75 |
| Max. Negotiated Rate |
$4,756.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,004.20
|
| Rate for Payer: Cash Price |
$3,004.20
|
| Rate for Payer: Cash Price |
$3,004.20
|
| Rate for Payer: Cigna Commercial |
$4,255.95
|
| Rate for Payer: First Health Commercial |
$4,506.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,506.30
|
| Rate for Payer: GEHA Commercial |
$4,005.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,506.30
|
| Rate for Payer: Humana ChoiceCare |
$1,301.82
|
| Rate for Payer: Multiplan All |
$4,556.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,004.20
|
| Rate for Payer: OMNI Networks Commercial |
$3,504.90
|
| Rate for Payer: One Health Plan PPO/POS |
$4,506.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,756.65
|
| Rate for Payer: Three Rivers Provider Network All |
$3,755.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,406.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,251.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,656.51
|
| Rate for Payer: Zelis Auto |
$2,002.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,503.50
|
|
|
IMPLT LINER ACETABULAR RINGLOC 36MM
|
Facility
|
OP
|
$4,297.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006179
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,074.25 |
| Max. Negotiated Rate |
$4,082.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,578.20
|
| Rate for Payer: Cash Price |
$2,578.20
|
| Rate for Payer: Cash Price |
$2,578.20
|
| Rate for Payer: Cigna Commercial |
$3,652.45
|
| Rate for Payer: First Health Commercial |
$3,867.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,867.30
|
| Rate for Payer: GEHA Commercial |
$3,437.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,867.30
|
| Rate for Payer: Humana ChoiceCare |
$1,117.22
|
| Rate for Payer: Multiplan All |
$3,910.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,578.20
|
| Rate for Payer: OMNI Networks Commercial |
$3,007.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,867.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,082.15
|
| Rate for Payer: Three Rivers Provider Network All |
$3,222.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,781.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,074.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,996.21
|
| Rate for Payer: Zelis Auto |
$1,718.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,148.50
|
|
|
IMPLT LINER ACETABULAR RINGLOC 36MM
|
Facility
|
IP
|
$4,297.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006179
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,718.80 |
| Max. Negotiated Rate |
$4,082.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,437.60
|
| Rate for Payer: Cash Price |
$2,578.20
|
| Rate for Payer: Cash Price |
$2,578.20
|
| Rate for Payer: Cigna Commercial |
$3,652.45
|
| Rate for Payer: First Health Commercial |
$3,867.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,867.30
|
| Rate for Payer: GEHA Commercial |
$3,007.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,867.30
|
| Rate for Payer: Multiplan All |
$3,910.27
|
| Rate for Payer: OMNI Networks Commercial |
$3,007.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,867.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,082.15
|
| Rate for Payer: Three Rivers Provider Network All |
$3,222.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,996.21
|
| Rate for Payer: Zelis Auto |
$1,718.80
|
|
|
IMPLT LINER ACETABULAR RINGLOC SIZE 23
|
Facility
|
OP
|
$3,456.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002089
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$864.00 |
| Max. Negotiated Rate |
$3,283.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,073.60
|
| Rate for Payer: Cash Price |
$2,073.60
|
| Rate for Payer: Cash Price |
$2,073.60
|
| Rate for Payer: Cigna Commercial |
$2,937.60
|
| Rate for Payer: First Health Commercial |
$3,110.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,110.40
|
| Rate for Payer: GEHA Commercial |
$2,764.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,110.40
|
| Rate for Payer: Humana ChoiceCare |
$898.56
|
| Rate for Payer: Multiplan All |
$3,144.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,073.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,419.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,110.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,283.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,592.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,041.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$864.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,214.08
|
| Rate for Payer: Zelis Auto |
$1,382.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,728.00
|
|
|
IMPLT LINER ACETABULAR RINGLOC SIZE 23
|
Facility
|
IP
|
$3,456.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002089
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,382.40 |
| Max. Negotiated Rate |
$3,283.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,764.80
|
| Rate for Payer: Cash Price |
$2,073.60
|
| Rate for Payer: Cash Price |
$2,073.60
|
| Rate for Payer: Cigna Commercial |
$2,937.60
|
| Rate for Payer: First Health Commercial |
$3,110.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,110.40
|
| Rate for Payer: GEHA Commercial |
$2,419.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,110.40
|
| Rate for Payer: Multiplan All |
$3,144.96
|
| Rate for Payer: OMNI Networks Commercial |
$2,419.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,110.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,283.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,592.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,214.08
|
| Rate for Payer: Zelis Auto |
$1,382.40
|
|
|
IMPLT LINER ACETABULAR SIZE22/28MM
|
Facility
|
OP
|
$5,892.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002248
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,473.00 |
| Max. Negotiated Rate |
$5,597.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,535.20
|
| Rate for Payer: Cash Price |
$3,535.20
|
| Rate for Payer: Cash Price |
$3,535.20
|
| Rate for Payer: Cigna Commercial |
$5,008.20
|
| Rate for Payer: First Health Commercial |
$5,302.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,302.80
|
| Rate for Payer: GEHA Commercial |
$4,713.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,302.80
|
| Rate for Payer: Humana ChoiceCare |
$1,531.92
|
| Rate for Payer: Multiplan All |
$5,361.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,535.20
|
| Rate for Payer: OMNI Networks Commercial |
$4,124.40
|
| Rate for Payer: One Health Plan PPO/POS |
$5,302.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,597.40
|
| Rate for Payer: Three Rivers Provider Network All |
$4,419.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,184.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,473.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,479.56
|
| Rate for Payer: Zelis Auto |
$2,356.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,946.00
|
|
|
IMPLT LINER ACETABULAR SIZE22/28MM
|
Facility
|
IP
|
$5,892.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002248
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,356.80 |
| Max. Negotiated Rate |
$5,597.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,713.60
|
| Rate for Payer: Cash Price |
$3,535.20
|
| Rate for Payer: Cash Price |
$3,535.20
|
| Rate for Payer: Cigna Commercial |
$5,008.20
|
| Rate for Payer: First Health Commercial |
$5,302.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,302.80
|
| Rate for Payer: GEHA Commercial |
$4,124.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,302.80
|
| Rate for Payer: Multiplan All |
$5,361.72
|
| Rate for Payer: OMNI Networks Commercial |
$4,124.40
|
| Rate for Payer: One Health Plan PPO/POS |
$5,302.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,597.40
|
| Rate for Payer: Three Rivers Provider Network All |
$4,419.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,479.56
|
| Rate for Payer: Zelis Auto |
$2,356.80
|
|
|
IMPLT LINER ACETABULAR SIZE 23/32MM
|
Facility
|
IP
|
$5,661.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002251
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,264.40 |
| Max. Negotiated Rate |
$5,377.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,528.80
|
| Rate for Payer: Cash Price |
$3,396.60
|
| Rate for Payer: Cash Price |
$3,396.60
|
| Rate for Payer: Cigna Commercial |
$4,811.85
|
| Rate for Payer: First Health Commercial |
$5,094.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,094.90
|
| Rate for Payer: GEHA Commercial |
$3,962.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,094.90
|
| Rate for Payer: Multiplan All |
$5,151.51
|
| Rate for Payer: OMNI Networks Commercial |
$3,962.70
|
| Rate for Payer: One Health Plan PPO/POS |
$5,094.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,377.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,245.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,264.73
|
| Rate for Payer: Zelis Auto |
$2,264.40
|
|
|
IMPLT LINER ACETABULAR SIZE 23/32MM
|
Facility
|
OP
|
$5,661.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002251
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,415.25 |
| Max. Negotiated Rate |
$5,377.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,396.60
|
| Rate for Payer: Cash Price |
$3,396.60
|
| Rate for Payer: Cash Price |
$3,396.60
|
| Rate for Payer: Cigna Commercial |
$4,811.85
|
| Rate for Payer: First Health Commercial |
$5,094.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,094.90
|
| Rate for Payer: GEHA Commercial |
$4,528.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,094.90
|
| Rate for Payer: Humana ChoiceCare |
$1,471.86
|
| Rate for Payer: Multiplan All |
$5,151.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,396.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,962.70
|
| Rate for Payer: One Health Plan PPO/POS |
$5,094.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,377.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,245.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,981.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,415.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,264.73
|
| Rate for Payer: Zelis Auto |
$2,264.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,830.50
|
|
|
IMPLT LINER ACETABULAR SIZE 23X32MM
|
Facility
|
OP
|
$9,479.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002252
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,369.75 |
| Max. Negotiated Rate |
$9,005.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,687.40
|
| Rate for Payer: Cash Price |
$5,687.40
|
| Rate for Payer: Cash Price |
$5,687.40
|
| Rate for Payer: Cigna Commercial |
$8,057.15
|
| Rate for Payer: First Health Commercial |
$8,531.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,531.10
|
| Rate for Payer: GEHA Commercial |
$7,583.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,531.10
|
| Rate for Payer: Humana ChoiceCare |
$2,464.54
|
| Rate for Payer: Multiplan All |
$8,625.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,687.40
|
| Rate for Payer: OMNI Networks Commercial |
$6,635.30
|
| Rate for Payer: One Health Plan PPO/POS |
$8,531.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9,005.05
|
| Rate for Payer: Three Rivers Provider Network All |
$7,109.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8,341.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,369.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,815.47
|
| Rate for Payer: Zelis Auto |
$3,791.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,739.50
|
|
|
IMPLT LINER ACETABULAR SIZE 23X32MM
|
Facility
|
IP
|
$9,479.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002252
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,791.60 |
| Max. Negotiated Rate |
$9,005.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7,583.20
|
| Rate for Payer: Cash Price |
$5,687.40
|
| Rate for Payer: Cash Price |
$5,687.40
|
| Rate for Payer: Cigna Commercial |
$8,057.15
|
| Rate for Payer: First Health Commercial |
$8,531.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,531.10
|
| Rate for Payer: GEHA Commercial |
$6,635.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,531.10
|
| Rate for Payer: Multiplan All |
$8,625.89
|
| Rate for Payer: OMNI Networks Commercial |
$6,635.30
|
| Rate for Payer: One Health Plan PPO/POS |
$8,531.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9,005.05
|
| Rate for Payer: Three Rivers Provider Network All |
$7,109.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,815.47
|
| Rate for Payer: Zelis Auto |
$3,791.60
|
|
|
IMPLT LINER BIPOLAR SHELL 46X28MM
|
Facility
|
OP
|
$2,284.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$571.00 |
| Max. Negotiated Rate |
$2,169.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,370.40
|
| Rate for Payer: Cash Price |
$1,370.40
|
| Rate for Payer: Cash Price |
$1,370.40
|
| Rate for Payer: Cigna Commercial |
$1,941.40
|
| Rate for Payer: First Health Commercial |
$2,055.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,055.60
|
| Rate for Payer: GEHA Commercial |
$1,827.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,055.60
|
| Rate for Payer: Humana ChoiceCare |
$593.84
|
| Rate for Payer: Multiplan All |
$2,078.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,370.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,598.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,055.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,169.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,713.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,009.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$571.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,124.12
|
| Rate for Payer: Zelis Auto |
$913.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,142.00
|
|
|
IMPLT LINER BIPOLAR SHELL 46X28MM
|
Facility
|
IP
|
$2,284.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$913.60 |
| Max. Negotiated Rate |
$2,169.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,827.20
|
| Rate for Payer: Cash Price |
$1,370.40
|
| Rate for Payer: Cash Price |
$1,370.40
|
| Rate for Payer: Cigna Commercial |
$1,941.40
|
| Rate for Payer: First Health Commercial |
$2,055.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,055.60
|
| Rate for Payer: GEHA Commercial |
$1,598.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,055.60
|
| Rate for Payer: Multiplan All |
$2,078.44
|
| Rate for Payer: OMNI Networks Commercial |
$1,598.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,055.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,169.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,713.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,124.12
|
| Rate for Payer: Zelis Auto |
$913.60
|
|
|
IMPLT LINER CEMENTLESS 36MM C
|
Facility
|
OP
|
$3,895.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$973.75 |
| Max. Negotiated Rate |
$3,700.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,337.00
|
| Rate for Payer: Cash Price |
$2,337.00
|
| Rate for Payer: Cash Price |
$2,337.00
|
| Rate for Payer: Cigna Commercial |
$3,310.75
|
| Rate for Payer: First Health Commercial |
$3,505.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,505.50
|
| Rate for Payer: GEHA Commercial |
$3,116.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,505.50
|
| Rate for Payer: Humana ChoiceCare |
$1,012.70
|
| Rate for Payer: Multiplan All |
$3,544.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,337.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,726.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,505.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,700.25
|
| Rate for Payer: Three Rivers Provider Network All |
$2,921.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,427.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$973.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,622.35
|
| Rate for Payer: Zelis Auto |
$1,558.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,947.50
|
|
|
IMPLT LINER CEMENTLESS 36MM C
|
Facility
|
IP
|
$3,895.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,558.00 |
| Max. Negotiated Rate |
$3,700.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,116.00
|
| Rate for Payer: Cash Price |
$2,337.00
|
| Rate for Payer: Cash Price |
$2,337.00
|
| Rate for Payer: Cigna Commercial |
$3,310.75
|
| Rate for Payer: First Health Commercial |
$3,505.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,505.50
|
| Rate for Payer: GEHA Commercial |
$2,726.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,505.50
|
| Rate for Payer: Multiplan All |
$3,544.45
|
| Rate for Payer: OMNI Networks Commercial |
$2,726.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,505.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,700.25
|
| Rate for Payer: Three Rivers Provider Network All |
$2,921.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,622.35
|
| Rate for Payer: Zelis Auto |
$1,558.00
|
|
|
IMPLT LINER CEMENTLESS 38MM
|
Facility
|
OP
|
$3,895.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002096
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$973.75 |
| Max. Negotiated Rate |
$3,700.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,337.00
|
| Rate for Payer: Cash Price |
$2,337.00
|
| Rate for Payer: Cash Price |
$2,337.00
|
| Rate for Payer: Cigna Commercial |
$3,310.75
|
| Rate for Payer: First Health Commercial |
$3,505.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,505.50
|
| Rate for Payer: GEHA Commercial |
$3,116.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,505.50
|
| Rate for Payer: Humana ChoiceCare |
$1,012.70
|
| Rate for Payer: Multiplan All |
$3,544.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,337.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,726.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,505.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,700.25
|
| Rate for Payer: Three Rivers Provider Network All |
$2,921.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,427.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$973.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,622.35
|
| Rate for Payer: Zelis Auto |
$1,558.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,947.50
|
|
|
IMPLT LINER CEMENTLESS 38MM
|
Facility
|
IP
|
$3,895.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002096
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,558.00 |
| Max. Negotiated Rate |
$3,700.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,116.00
|
| Rate for Payer: Cash Price |
$2,337.00
|
| Rate for Payer: Cash Price |
$2,337.00
|
| Rate for Payer: Cigna Commercial |
$3,310.75
|
| Rate for Payer: First Health Commercial |
$3,505.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,505.50
|
| Rate for Payer: GEHA Commercial |
$2,726.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,505.50
|
| Rate for Payer: Multiplan All |
$3,544.45
|
| Rate for Payer: OMNI Networks Commercial |
$2,726.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,505.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,700.25
|
| Rate for Payer: Three Rivers Provider Network All |
$2,921.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,622.35
|
| Rate for Payer: Zelis Auto |
$1,558.00
|
|
|
IMPLT LINER CEMENTLESS 42MM
|
Facility
|
IP
|
$3,895.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,558.00 |
| Max. Negotiated Rate |
$3,700.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,116.00
|
| Rate for Payer: Cash Price |
$2,337.00
|
| Rate for Payer: Cash Price |
$2,337.00
|
| Rate for Payer: Cigna Commercial |
$3,310.75
|
| Rate for Payer: First Health Commercial |
$3,505.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,505.50
|
| Rate for Payer: GEHA Commercial |
$2,726.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,505.50
|
| Rate for Payer: Multiplan All |
$3,544.45
|
| Rate for Payer: OMNI Networks Commercial |
$2,726.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,505.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,700.25
|
| Rate for Payer: Three Rivers Provider Network All |
$2,921.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,622.35
|
| Rate for Payer: Zelis Auto |
$1,558.00
|
|
|
IMPLT LINER CEMENTLESS 42MM
|
Facility
|
OP
|
$3,895.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$973.75 |
| Max. Negotiated Rate |
$3,700.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,337.00
|
| Rate for Payer: Cash Price |
$2,337.00
|
| Rate for Payer: Cash Price |
$2,337.00
|
| Rate for Payer: Cigna Commercial |
$3,310.75
|
| Rate for Payer: First Health Commercial |
$3,505.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,505.50
|
| Rate for Payer: GEHA Commercial |
$3,116.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,505.50
|
| Rate for Payer: Humana ChoiceCare |
$1,012.70
|
| Rate for Payer: Multiplan All |
$3,544.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,337.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,726.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,505.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,700.25
|
| Rate for Payer: Three Rivers Provider Network All |
$2,921.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,427.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$973.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,622.35
|
| Rate for Payer: Zelis Auto |
$1,558.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,947.50
|
|
