|
IMPLT MOLD CEMENT HEAD HIP S1S 48MM
|
Facility
|
OP
|
$4,105.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002938
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,026.25 |
| Max. Negotiated Rate |
$3,899.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,463.00
|
| Rate for Payer: Cash Price |
$2,463.00
|
| Rate for Payer: Cash Price |
$2,463.00
|
| Rate for Payer: Cigna Commercial |
$3,489.25
|
| Rate for Payer: First Health Commercial |
$3,694.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,694.50
|
| Rate for Payer: GEHA Commercial |
$3,284.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,694.50
|
| Rate for Payer: Humana ChoiceCare |
$1,067.30
|
| Rate for Payer: Multiplan All |
$3,735.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,463.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,873.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,694.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,899.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3,078.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,612.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,026.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,817.65
|
| Rate for Payer: Zelis Auto |
$1,642.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,052.50
|
|
|
IMPLT MOLD CEMENT HEAD HIP S1S 48MM
|
Facility
|
IP
|
$4,105.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002938
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,642.00 |
| Max. Negotiated Rate |
$3,899.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,284.00
|
| Rate for Payer: Cash Price |
$2,463.00
|
| Rate for Payer: Cash Price |
$2,463.00
|
| Rate for Payer: Cigna Commercial |
$3,489.25
|
| Rate for Payer: First Health Commercial |
$3,694.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,694.50
|
| Rate for Payer: GEHA Commercial |
$2,873.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,694.50
|
| Rate for Payer: Multiplan All |
$3,735.55
|
| Rate for Payer: OMNI Networks Commercial |
$2,873.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,694.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,899.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3,078.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,817.65
|
| Rate for Payer: Zelis Auto |
$1,642.00
|
|
|
IMPLT MOLD CEMENT KNEE FEMORAL 70MM
|
Facility
|
OP
|
$6,334.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002098
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,583.50 |
| Max. Negotiated Rate |
$6,017.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,800.40
|
| Rate for Payer: Cash Price |
$3,800.40
|
| Rate for Payer: Cash Price |
$3,800.40
|
| Rate for Payer: Cigna Commercial |
$5,383.90
|
| Rate for Payer: First Health Commercial |
$5,700.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,700.60
|
| Rate for Payer: GEHA Commercial |
$5,067.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,700.60
|
| Rate for Payer: Humana ChoiceCare |
$1,646.84
|
| Rate for Payer: Multiplan All |
$5,763.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,800.40
|
| Rate for Payer: OMNI Networks Commercial |
$4,433.80
|
| Rate for Payer: One Health Plan PPO/POS |
$5,700.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,017.30
|
| Rate for Payer: Three Rivers Provider Network All |
$4,750.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,573.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,583.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,890.62
|
| Rate for Payer: Zelis Auto |
$2,533.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,167.00
|
|
|
IMPLT MOLD CEMENT KNEE FEMORAL 70MM
|
Facility
|
IP
|
$6,334.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002098
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,533.60 |
| Max. Negotiated Rate |
$6,017.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,067.20
|
| Rate for Payer: Cash Price |
$3,800.40
|
| Rate for Payer: Cash Price |
$3,800.40
|
| Rate for Payer: Cigna Commercial |
$5,383.90
|
| Rate for Payer: First Health Commercial |
$5,700.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,700.60
|
| Rate for Payer: GEHA Commercial |
$4,433.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,700.60
|
| Rate for Payer: Multiplan All |
$5,763.94
|
| Rate for Payer: OMNI Networks Commercial |
$4,433.80
|
| Rate for Payer: One Health Plan PPO/POS |
$5,700.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,017.30
|
| Rate for Payer: Three Rivers Provider Network All |
$4,750.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,890.62
|
| Rate for Payer: Zelis Auto |
$2,533.60
|
|
|
IMPLT MOLD CEMENT KNEE TIBIAL 80MM
|
Facility
|
OP
|
$3,429.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$857.25 |
| Max. Negotiated Rate |
$3,257.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,057.40
|
| Rate for Payer: Cash Price |
$2,057.40
|
| Rate for Payer: Cash Price |
$2,057.40
|
| Rate for Payer: Cigna Commercial |
$2,914.65
|
| Rate for Payer: First Health Commercial |
$3,086.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,086.10
|
| Rate for Payer: GEHA Commercial |
$2,743.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,086.10
|
| Rate for Payer: Humana ChoiceCare |
$891.54
|
| Rate for Payer: Multiplan All |
$3,120.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,057.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,400.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,086.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,257.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,571.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,017.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$857.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,188.97
|
| Rate for Payer: Zelis Auto |
$1,371.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,714.50
|
|
|
IMPLT MOLD CEMENT KNEE TIBIAL 80MM
|
Facility
|
IP
|
$3,429.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,371.60 |
| Max. Negotiated Rate |
$3,257.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,743.20
|
| Rate for Payer: Cash Price |
$2,057.40
|
| Rate for Payer: Cash Price |
$2,057.40
|
| Rate for Payer: Cigna Commercial |
$2,914.65
|
| Rate for Payer: First Health Commercial |
$3,086.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,086.10
|
| Rate for Payer: GEHA Commercial |
$2,400.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,086.10
|
| Rate for Payer: Multiplan All |
$3,120.39
|
| Rate for Payer: OMNI Networks Commercial |
$2,400.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,086.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,257.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,571.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,188.97
|
| Rate for Payer: Zelis Auto |
$1,371.60
|
|
|
IMPLT MOLD CEMENT TIBIAL KNEE 65MM
|
Facility
|
IP
|
$4,872.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001595
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,948.80 |
| Max. Negotiated Rate |
$4,628.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,897.60
|
| Rate for Payer: Cash Price |
$2,923.20
|
| Rate for Payer: Cash Price |
$2,923.20
|
| Rate for Payer: Cigna Commercial |
$4,141.20
|
| Rate for Payer: First Health Commercial |
$4,384.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,384.80
|
| Rate for Payer: GEHA Commercial |
$3,410.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,384.80
|
| Rate for Payer: Multiplan All |
$4,433.52
|
| Rate for Payer: OMNI Networks Commercial |
$3,410.40
|
| Rate for Payer: One Health Plan PPO/POS |
$4,384.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,628.40
|
| Rate for Payer: Three Rivers Provider Network All |
$3,654.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,530.96
|
| Rate for Payer: Zelis Auto |
$1,948.80
|
|
|
IMPLT MOLD CEMENT TIBIAL KNEE 65MM
|
Facility
|
OP
|
$4,872.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001595
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,218.00 |
| Max. Negotiated Rate |
$4,628.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,923.20
|
| Rate for Payer: Cash Price |
$2,923.20
|
| Rate for Payer: Cash Price |
$2,923.20
|
| Rate for Payer: Cigna Commercial |
$4,141.20
|
| Rate for Payer: First Health Commercial |
$4,384.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,384.80
|
| Rate for Payer: GEHA Commercial |
$3,897.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,384.80
|
| Rate for Payer: Humana ChoiceCare |
$1,266.72
|
| Rate for Payer: Multiplan All |
$4,433.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,923.20
|
| Rate for Payer: OMNI Networks Commercial |
$3,410.40
|
| Rate for Payer: One Health Plan PPO/POS |
$4,384.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,628.40
|
| Rate for Payer: Three Rivers Provider Network All |
$3,654.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,287.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,218.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,530.96
|
| Rate for Payer: Zelis Auto |
$1,948.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,436.00
|
|
|
IMPLT MOLD HIP STEM W/REINF 9MMX200MM
|
Facility
|
IP
|
$4,945.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003003
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,978.00 |
| Max. Negotiated Rate |
$4,697.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,956.00
|
| Rate for Payer: Cash Price |
$2,967.00
|
| Rate for Payer: Cash Price |
$2,967.00
|
| Rate for Payer: Cigna Commercial |
$4,203.25
|
| Rate for Payer: First Health Commercial |
$4,450.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,450.50
|
| Rate for Payer: GEHA Commercial |
$3,461.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,450.50
|
| Rate for Payer: Multiplan All |
$4,499.95
|
| Rate for Payer: OMNI Networks Commercial |
$3,461.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4,450.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,697.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3,708.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,598.85
|
| Rate for Payer: Zelis Auto |
$1,978.00
|
|
|
IMPLT MOLD HIP STEM W/REINF 9MMX200MM
|
Facility
|
OP
|
$4,945.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003003
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,236.25 |
| Max. Negotiated Rate |
$4,697.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,967.00
|
| Rate for Payer: Cash Price |
$2,967.00
|
| Rate for Payer: Cash Price |
$2,967.00
|
| Rate for Payer: Cigna Commercial |
$4,203.25
|
| Rate for Payer: First Health Commercial |
$4,450.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,450.50
|
| Rate for Payer: GEHA Commercial |
$3,956.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,450.50
|
| Rate for Payer: Humana ChoiceCare |
$1,285.70
|
| Rate for Payer: Multiplan All |
$4,499.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,967.00
|
| Rate for Payer: OMNI Networks Commercial |
$3,461.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4,450.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,697.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3,708.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,351.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,236.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,598.85
|
| Rate for Payer: Zelis Auto |
$1,978.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,472.50
|
|
|
IMPLT MOLD SPACER CEMENT FEMORAL 75X57MM
|
Facility
|
IP
|
$9,379.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002837
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,751.60 |
| Max. Negotiated Rate |
$8,910.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7,503.20
|
| Rate for Payer: Cash Price |
$5,627.40
|
| Rate for Payer: Cash Price |
$5,627.40
|
| Rate for Payer: Cigna Commercial |
$7,972.15
|
| Rate for Payer: First Health Commercial |
$8,441.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,441.10
|
| Rate for Payer: GEHA Commercial |
$6,565.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,441.10
|
| Rate for Payer: Multiplan All |
$8,534.89
|
| Rate for Payer: OMNI Networks Commercial |
$6,565.30
|
| Rate for Payer: One Health Plan PPO/POS |
$8,441.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,910.05
|
| Rate for Payer: Three Rivers Provider Network All |
$7,034.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,722.47
|
| Rate for Payer: Zelis Auto |
$3,751.60
|
|
|
IMPLT MOLD SPACER CEMENT FEMORAL 75X57MM
|
Facility
|
OP
|
$9,379.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002837
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,344.75 |
| Max. Negotiated Rate |
$8,910.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,627.40
|
| Rate for Payer: Cash Price |
$5,627.40
|
| Rate for Payer: Cash Price |
$5,627.40
|
| Rate for Payer: Cigna Commercial |
$7,972.15
|
| Rate for Payer: First Health Commercial |
$8,441.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,441.10
|
| Rate for Payer: GEHA Commercial |
$7,503.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,441.10
|
| Rate for Payer: Humana ChoiceCare |
$2,438.54
|
| Rate for Payer: Multiplan All |
$8,534.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,627.40
|
| Rate for Payer: OMNI Networks Commercial |
$6,565.30
|
| Rate for Payer: One Health Plan PPO/POS |
$8,441.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,910.05
|
| Rate for Payer: Three Rivers Provider Network All |
$7,034.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8,253.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,344.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,722.47
|
| Rate for Payer: Zelis Auto |
$3,751.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,689.50
|
|
|
IMPLT MOLD SPACER CEMENT HEAD HIP 60MM
|
Facility
|
OP
|
$4,105.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,026.25 |
| Max. Negotiated Rate |
$3,899.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,463.00
|
| Rate for Payer: Cash Price |
$2,463.00
|
| Rate for Payer: Cash Price |
$2,463.00
|
| Rate for Payer: Cigna Commercial |
$3,489.25
|
| Rate for Payer: First Health Commercial |
$3,694.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,694.50
|
| Rate for Payer: GEHA Commercial |
$3,284.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,694.50
|
| Rate for Payer: Humana ChoiceCare |
$1,067.30
|
| Rate for Payer: Multiplan All |
$3,735.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,463.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,873.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,694.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,899.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3,078.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,612.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,026.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,817.65
|
| Rate for Payer: Zelis Auto |
$1,642.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,052.50
|
|
|
IMPLT MOLD SPACER CEMENT HEAD HIP 60MM
|
Facility
|
IP
|
$4,105.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,642.00 |
| Max. Negotiated Rate |
$3,899.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,284.00
|
| Rate for Payer: Cash Price |
$2,463.00
|
| Rate for Payer: Cash Price |
$2,463.00
|
| Rate for Payer: Cigna Commercial |
$3,489.25
|
| Rate for Payer: First Health Commercial |
$3,694.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,694.50
|
| Rate for Payer: GEHA Commercial |
$2,873.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,694.50
|
| Rate for Payer: Multiplan All |
$3,735.55
|
| Rate for Payer: OMNI Networks Commercial |
$2,873.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,694.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,899.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3,078.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,817.65
|
| Rate for Payer: Zelis Auto |
$1,642.00
|
|
|
IMPLT MOLD SPACER CEMENT TIBIAL 75X45MM
|
Facility
|
OP
|
$3,429.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002099
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$857.25 |
| Max. Negotiated Rate |
$3,257.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,057.40
|
| Rate for Payer: Cash Price |
$2,057.40
|
| Rate for Payer: Cash Price |
$2,057.40
|
| Rate for Payer: Cigna Commercial |
$2,914.65
|
| Rate for Payer: First Health Commercial |
$3,086.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,086.10
|
| Rate for Payer: GEHA Commercial |
$2,743.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,086.10
|
| Rate for Payer: Humana ChoiceCare |
$891.54
|
| Rate for Payer: Multiplan All |
$3,120.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,057.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,400.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,086.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,257.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,571.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,017.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$857.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,188.97
|
| Rate for Payer: Zelis Auto |
$1,371.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,714.50
|
|
|
IMPLT MOLD SPACER CEMENT TIBIAL 75X45MM
|
Facility
|
IP
|
$3,429.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002099
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,371.60 |
| Max. Negotiated Rate |
$3,257.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,743.20
|
| Rate for Payer: Cash Price |
$2,057.40
|
| Rate for Payer: Cash Price |
$2,057.40
|
| Rate for Payer: Cigna Commercial |
$2,914.65
|
| Rate for Payer: First Health Commercial |
$3,086.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,086.10
|
| Rate for Payer: GEHA Commercial |
$2,400.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,086.10
|
| Rate for Payer: Multiplan All |
$3,120.39
|
| Rate for Payer: OMNI Networks Commercial |
$2,400.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,086.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,257.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,571.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,188.97
|
| Rate for Payer: Zelis Auto |
$1,371.60
|
|
|
IMPLT MON LNQ11 REVEAL LOOP RECORDER
|
Facility
|
IP
|
$16,428.00
|
|
|
Service Code
|
CPT C1764
|
| Hospital Charge Code |
7006365
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,571.20 |
| Max. Negotiated Rate |
$15,606.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$13,142.40
|
| Rate for Payer: Cash Price |
$9,856.80
|
| Rate for Payer: Cash Price |
$9,856.80
|
| Rate for Payer: Cigna Commercial |
$13,963.80
|
| Rate for Payer: First Health Commercial |
$14,785.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$14,785.20
|
| Rate for Payer: GEHA Commercial |
$11,499.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$14,785.20
|
| Rate for Payer: Multiplan All |
$14,949.48
|
| Rate for Payer: OMNI Networks Commercial |
$11,499.60
|
| Rate for Payer: One Health Plan PPO/POS |
$14,785.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$15,606.60
|
| Rate for Payer: Three Rivers Provider Network All |
$12,321.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$15,278.04
|
| Rate for Payer: Zelis Auto |
$6,571.20
|
|
|
IMPLT MON LNQ11 REVEAL LOOP RECORDER
|
Facility
|
OP
|
$16,428.00
|
|
|
Service Code
|
CPT C1764
|
| Hospital Charge Code |
7006365
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,107.00 |
| Max. Negotiated Rate |
$15,606.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9,856.80
|
| Rate for Payer: Cash Price |
$9,856.80
|
| Rate for Payer: Cash Price |
$9,856.80
|
| Rate for Payer: Cigna Commercial |
$13,963.80
|
| Rate for Payer: First Health Commercial |
$14,785.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$14,785.20
|
| Rate for Payer: GEHA Commercial |
$13,142.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$14,785.20
|
| Rate for Payer: Humana ChoiceCare |
$4,271.28
|
| Rate for Payer: Multiplan All |
$14,949.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,856.80
|
| Rate for Payer: OMNI Networks Commercial |
$11,499.60
|
| Rate for Payer: One Health Plan PPO/POS |
$14,785.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$15,606.60
|
| Rate for Payer: Three Rivers Provider Network All |
$12,321.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14,456.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,107.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$15,278.04
|
| Rate for Payer: Zelis Auto |
$6,571.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,214.00
|
|
|
IMPLT NAIL 3.5X450
|
Facility
|
OP
|
$209.76
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
70000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.44 |
| Max. Negotiated Rate |
$199.27 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$125.86
|
| Rate for Payer: Cash Price |
$125.86
|
| Rate for Payer: Cash Price |
$125.86
|
| Rate for Payer: Cigna Commercial |
$178.30
|
| Rate for Payer: First Health Commercial |
$188.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$188.78
|
| Rate for Payer: GEHA Commercial |
$167.81
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$188.78
|
| Rate for Payer: Humana ChoiceCare |
$54.54
|
| Rate for Payer: Multiplan All |
$190.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$125.86
|
| Rate for Payer: OMNI Networks Commercial |
$146.83
|
| Rate for Payer: One Health Plan PPO/POS |
$188.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$199.27
|
| Rate for Payer: Three Rivers Provider Network All |
$157.32
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$52.44
|
| Rate for Payer: United Payors & United Providers UP&UP |
$195.08
|
| Rate for Payer: Zelis Auto |
$83.90
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$104.88
|
|
|
IMPLT NAIL 3.5X450
|
Facility
|
IP
|
$209.76
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
70000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$83.90 |
| Max. Negotiated Rate |
$199.27 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$167.81
|
| Rate for Payer: Cash Price |
$125.86
|
| Rate for Payer: Cash Price |
$125.86
|
| Rate for Payer: Cigna Commercial |
$178.30
|
| Rate for Payer: First Health Commercial |
$188.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$188.78
|
| Rate for Payer: GEHA Commercial |
$146.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$188.78
|
| Rate for Payer: Multiplan All |
$190.88
|
| Rate for Payer: OMNI Networks Commercial |
$146.83
|
| Rate for Payer: One Health Plan PPO/POS |
$188.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$199.27
|
| Rate for Payer: Three Rivers Provider Network All |
$157.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$195.08
|
| Rate for Payer: Zelis Auto |
$83.90
|
|
|
IMPLT NAIL 3X450
|
Facility
|
OP
|
$203.68
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$50.92 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$122.21
|
| Rate for Payer: Cash Price |
$122.21
|
| Rate for Payer: Cash Price |
$122.21
|
| Rate for Payer: Cigna Commercial |
$173.13
|
| Rate for Payer: First Health Commercial |
$183.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$183.31
|
| Rate for Payer: GEHA Commercial |
$162.94
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$183.31
|
| Rate for Payer: Humana ChoiceCare |
$52.96
|
| Rate for Payer: Multiplan All |
$185.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$122.21
|
| Rate for Payer: OMNI Networks Commercial |
$142.58
|
| Rate for Payer: One Health Plan PPO/POS |
$183.31
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$193.50
|
| Rate for Payer: Three Rivers Provider Network All |
$152.76
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$179.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$50.92
|
| Rate for Payer: United Payors & United Providers UP&UP |
$189.42
|
| Rate for Payer: Zelis Auto |
$81.47
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$101.84
|
|
|
IMPLT NAIL 3X450
|
Facility
|
IP
|
$203.68
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.47 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$162.94
|
| Rate for Payer: Cash Price |
$122.21
|
| Rate for Payer: Cash Price |
$122.21
|
| Rate for Payer: Cigna Commercial |
$173.13
|
| Rate for Payer: First Health Commercial |
$183.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$183.31
|
| Rate for Payer: GEHA Commercial |
$142.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$183.31
|
| Rate for Payer: Multiplan All |
$185.35
|
| Rate for Payer: OMNI Networks Commercial |
$142.58
|
| Rate for Payer: One Health Plan PPO/POS |
$183.31
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$193.50
|
| Rate for Payer: Three Rivers Provider Network All |
$152.76
|
| Rate for Payer: United Payors & United Providers UP&UP |
$189.42
|
| Rate for Payer: Zelis Auto |
$81.47
|
|
|
IMPLT NAIL ALPHA TIBIA T2
|
Facility
|
IP
|
$5,195.19
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009279
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,078.08 |
| Max. Negotiated Rate |
$4,935.43 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,156.15
|
| Rate for Payer: Cash Price |
$3,117.11
|
| Rate for Payer: Cash Price |
$3,117.11
|
| Rate for Payer: Cigna Commercial |
$4,415.91
|
| Rate for Payer: First Health Commercial |
$4,675.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,675.67
|
| Rate for Payer: GEHA Commercial |
$3,636.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,675.67
|
| Rate for Payer: Multiplan All |
$4,727.62
|
| Rate for Payer: OMNI Networks Commercial |
$3,636.63
|
| Rate for Payer: One Health Plan PPO/POS |
$4,675.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,935.43
|
| Rate for Payer: Three Rivers Provider Network All |
$3,896.39
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,831.53
|
| Rate for Payer: Zelis Auto |
$2,078.08
|
|
|
IMPLT NAIL ALPHA TIBIA T2
|
Facility
|
OP
|
$5,195.19
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009279
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,298.80 |
| Max. Negotiated Rate |
$4,935.43 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,117.11
|
| Rate for Payer: Cash Price |
$3,117.11
|
| Rate for Payer: Cash Price |
$3,117.11
|
| Rate for Payer: Cigna Commercial |
$4,415.91
|
| Rate for Payer: First Health Commercial |
$4,675.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,675.67
|
| Rate for Payer: GEHA Commercial |
$4,156.15
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,675.67
|
| Rate for Payer: Humana ChoiceCare |
$1,350.75
|
| Rate for Payer: Multiplan All |
$4,727.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,117.11
|
| Rate for Payer: OMNI Networks Commercial |
$3,636.63
|
| Rate for Payer: One Health Plan PPO/POS |
$4,675.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,935.43
|
| Rate for Payer: Three Rivers Provider Network All |
$3,896.39
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,571.77
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,298.80
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,831.53
|
| Rate for Payer: Zelis Auto |
$2,078.08
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,597.59
|
|
|
IMPLT NAIL FEMORAL 11X340MM
|
Facility
|
IP
|
$4,882.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,952.80 |
| Max. Negotiated Rate |
$4,637.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,905.60
|
| Rate for Payer: Cash Price |
$2,929.20
|
| Rate for Payer: Cash Price |
$2,929.20
|
| Rate for Payer: Cigna Commercial |
$4,149.70
|
| Rate for Payer: First Health Commercial |
$4,393.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,393.80
|
| Rate for Payer: GEHA Commercial |
$3,417.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,393.80
|
| Rate for Payer: Multiplan All |
$4,442.62
|
| Rate for Payer: OMNI Networks Commercial |
$3,417.40
|
| Rate for Payer: One Health Plan PPO/POS |
$4,393.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,637.90
|
| Rate for Payer: Three Rivers Provider Network All |
$3,661.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,540.26
|
| Rate for Payer: Zelis Auto |
$1,952.80
|
|
