|
IMPLT PARTIALLY THREADED 205.044
|
Facility
|
IP
|
$1,164.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000290
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.60 |
| Max. Negotiated Rate |
$1,105.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$931.20
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cigna Commercial |
$989.40
|
| Rate for Payer: First Health Commercial |
$1,047.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,047.60
|
| Rate for Payer: GEHA Commercial |
$814.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,047.60
|
| Rate for Payer: Multiplan All |
$1,059.24
|
| Rate for Payer: OMNI Networks Commercial |
$814.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,047.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,105.80
|
| Rate for Payer: Three Rivers Provider Network All |
$873.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,082.52
|
| Rate for Payer: Zelis Auto |
$465.60
|
|
|
IMPLT PARTIALLY THREADED 205.046
|
Facility
|
IP
|
$1,216.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000291
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$486.40 |
| Max. Negotiated Rate |
$1,155.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$972.80
|
| Rate for Payer: Cash Price |
$729.60
|
| Rate for Payer: Cash Price |
$729.60
|
| Rate for Payer: Cigna Commercial |
$1,033.60
|
| Rate for Payer: First Health Commercial |
$1,094.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,094.40
|
| Rate for Payer: GEHA Commercial |
$851.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,094.40
|
| Rate for Payer: Multiplan All |
$1,106.56
|
| Rate for Payer: OMNI Networks Commercial |
$851.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,094.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,155.20
|
| Rate for Payer: Three Rivers Provider Network All |
$912.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,130.88
|
| Rate for Payer: Zelis Auto |
$486.40
|
|
|
IMPLT PARTIALLY THREADED 205.046
|
Facility
|
OP
|
$1,216.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000291
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$304.00 |
| Max. Negotiated Rate |
$1,155.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$729.60
|
| Rate for Payer: Cash Price |
$729.60
|
| Rate for Payer: Cash Price |
$729.60
|
| Rate for Payer: Cigna Commercial |
$1,033.60
|
| Rate for Payer: First Health Commercial |
$1,094.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,094.40
|
| Rate for Payer: GEHA Commercial |
$972.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,094.40
|
| Rate for Payer: Humana ChoiceCare |
$316.16
|
| Rate for Payer: Multiplan All |
$1,106.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$729.60
|
| Rate for Payer: OMNI Networks Commercial |
$851.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,094.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,155.20
|
| Rate for Payer: Three Rivers Provider Network All |
$912.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,070.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$304.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,130.88
|
| Rate for Payer: Zelis Auto |
$486.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$608.00
|
|
|
IMPLT PASSPORT KIT 12FX2CM
|
Facility
|
OP
|
$1,282.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
7002891
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$320.50 |
| Max. Negotiated Rate |
$1,217.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$769.20
|
| Rate for Payer: Cash Price |
$769.20
|
| Rate for Payer: Cash Price |
$769.20
|
| Rate for Payer: Cigna Commercial |
$1,089.70
|
| Rate for Payer: First Health Commercial |
$1,153.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,153.80
|
| Rate for Payer: GEHA Commercial |
$1,025.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,153.80
|
| Rate for Payer: Humana ChoiceCare |
$333.32
|
| Rate for Payer: Multiplan All |
$1,166.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$769.20
|
| Rate for Payer: OMNI Networks Commercial |
$897.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,153.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,217.90
|
| Rate for Payer: Three Rivers Provider Network All |
$961.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,128.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$320.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,192.26
|
| Rate for Payer: Zelis Auto |
$512.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$641.00
|
|
|
IMPLT PASSPORT KIT 12FX2CM
|
Facility
|
IP
|
$1,282.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
7002891
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$512.80 |
| Max. Negotiated Rate |
$1,217.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,025.60
|
| Rate for Payer: Cash Price |
$769.20
|
| Rate for Payer: Cash Price |
$769.20
|
| Rate for Payer: Cigna Commercial |
$1,089.70
|
| Rate for Payer: First Health Commercial |
$1,153.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,153.80
|
| Rate for Payer: GEHA Commercial |
$897.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,153.80
|
| Rate for Payer: Multiplan All |
$1,166.62
|
| Rate for Payer: OMNI Networks Commercial |
$897.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,153.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,217.90
|
| Rate for Payer: Three Rivers Provider Network All |
$961.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,192.26
|
| Rate for Payer: Zelis Auto |
$512.80
|
|
|
IMPLT PATCH CURASOFT SMALL
|
Facility
|
IP
|
$1,604.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7006522
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$641.60 |
| Max. Negotiated Rate |
$1,523.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,283.20
|
| Rate for Payer: Cash Price |
$962.40
|
| Rate for Payer: Cash Price |
$962.40
|
| Rate for Payer: Cigna Commercial |
$1,363.40
|
| Rate for Payer: First Health Commercial |
$1,443.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,443.60
|
| Rate for Payer: GEHA Commercial |
$1,122.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,443.60
|
| Rate for Payer: Multiplan All |
$1,459.64
|
| Rate for Payer: OMNI Networks Commercial |
$1,122.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,443.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,523.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,203.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,491.72
|
| Rate for Payer: Zelis Auto |
$641.60
|
|
|
IMPLT PATCH CURASOFT SMALL
|
Facility
|
OP
|
$1,604.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7006522
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$401.00 |
| Max. Negotiated Rate |
$1,523.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$962.40
|
| Rate for Payer: Cash Price |
$962.40
|
| Rate for Payer: Cash Price |
$962.40
|
| Rate for Payer: Cigna Commercial |
$1,363.40
|
| Rate for Payer: First Health Commercial |
$1,443.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,443.60
|
| Rate for Payer: GEHA Commercial |
$1,283.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,443.60
|
| Rate for Payer: Humana ChoiceCare |
$417.04
|
| Rate for Payer: Multiplan All |
$1,459.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$962.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,122.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,443.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,523.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,203.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,411.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$401.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,491.72
|
| Rate for Payer: Zelis Auto |
$641.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$802.00
|
|
|
IMPLT PATELLA A35X10MM ASYMMETRIC
|
Facility
|
OP
|
$2,588.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002785
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.00 |
| Max. Negotiated Rate |
$2,458.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,552.80
|
| Rate for Payer: Cash Price |
$1,552.80
|
| Rate for Payer: Cash Price |
$1,552.80
|
| Rate for Payer: Cigna Commercial |
$2,199.80
|
| Rate for Payer: First Health Commercial |
$2,329.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,329.20
|
| Rate for Payer: GEHA Commercial |
$2,070.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,329.20
|
| Rate for Payer: Humana ChoiceCare |
$672.88
|
| Rate for Payer: Multiplan All |
$2,355.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,552.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,811.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,329.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,458.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,941.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,277.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$647.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,406.84
|
| Rate for Payer: Zelis Auto |
$1,035.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,294.00
|
|
|
IMPLT PATELLA A35X10MM ASYMMETRIC
|
Facility
|
IP
|
$2,588.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002785
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,035.20 |
| Max. Negotiated Rate |
$2,458.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,070.40
|
| Rate for Payer: Cash Price |
$1,552.80
|
| Rate for Payer: Cash Price |
$1,552.80
|
| Rate for Payer: Cigna Commercial |
$2,199.80
|
| Rate for Payer: First Health Commercial |
$2,329.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,329.20
|
| Rate for Payer: GEHA Commercial |
$1,811.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,329.20
|
| Rate for Payer: Multiplan All |
$2,355.08
|
| Rate for Payer: OMNI Networks Commercial |
$1,811.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,329.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,458.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,941.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,406.84
|
| Rate for Payer: Zelis Auto |
$1,035.20
|
|
|
IMPLT PATELLA ASYMMETRIC A29X9MM
|
Facility
|
IP
|
$2,223.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$889.20 |
| Max. Negotiated Rate |
$2,111.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,778.40
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cigna Commercial |
$1,889.55
|
| Rate for Payer: First Health Commercial |
$2,000.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,000.70
|
| Rate for Payer: GEHA Commercial |
$1,556.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,000.70
|
| Rate for Payer: Multiplan All |
$2,022.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,556.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,000.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,111.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,667.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,067.39
|
| Rate for Payer: Zelis Auto |
$889.20
|
|
|
IMPLT PATELLA ASYMMETRIC A29X9MM
|
Facility
|
OP
|
$2,223.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$555.75 |
| Max. Negotiated Rate |
$2,111.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,333.80
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cigna Commercial |
$1,889.55
|
| Rate for Payer: First Health Commercial |
$2,000.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,000.70
|
| Rate for Payer: GEHA Commercial |
$1,778.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,000.70
|
| Rate for Payer: Humana ChoiceCare |
$577.98
|
| Rate for Payer: Multiplan All |
$2,022.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,333.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,556.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,000.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,111.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,667.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,956.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$555.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,067.39
|
| Rate for Payer: Zelis Auto |
$889.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,111.50
|
|
|
IMPLT PATELLA ASYMMETRIC A32MMX 10MM
|
Facility
|
OP
|
$2,290.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002731
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$572.50 |
| Max. Negotiated Rate |
$2,175.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,374.00
|
| Rate for Payer: Cash Price |
$1,374.00
|
| Rate for Payer: Cash Price |
$1,374.00
|
| Rate for Payer: Cigna Commercial |
$1,946.50
|
| Rate for Payer: First Health Commercial |
$2,061.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,061.00
|
| Rate for Payer: GEHA Commercial |
$1,832.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,061.00
|
| Rate for Payer: Humana ChoiceCare |
$595.40
|
| Rate for Payer: Multiplan All |
$2,083.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,374.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,603.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,061.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,175.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,717.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,015.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$572.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,129.70
|
| Rate for Payer: Zelis Auto |
$916.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,145.00
|
|
|
IMPLT PATELLA ASYMMETRIC A32MMX 10MM
|
Facility
|
IP
|
$2,290.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002731
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$916.00 |
| Max. Negotiated Rate |
$2,175.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,832.00
|
| Rate for Payer: Cash Price |
$1,374.00
|
| Rate for Payer: Cash Price |
$1,374.00
|
| Rate for Payer: Cigna Commercial |
$1,946.50
|
| Rate for Payer: First Health Commercial |
$2,061.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,061.00
|
| Rate for Payer: GEHA Commercial |
$1,603.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,061.00
|
| Rate for Payer: Multiplan All |
$2,083.90
|
| Rate for Payer: OMNI Networks Commercial |
$1,603.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,061.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,175.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,717.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,129.70
|
| Rate for Payer: Zelis Auto |
$916.00
|
|
|
IMPLT PATELLA ASYMMETRIC A35
|
Facility
|
OP
|
$2,223.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$555.75 |
| Max. Negotiated Rate |
$2,111.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,333.80
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cigna Commercial |
$1,889.55
|
| Rate for Payer: First Health Commercial |
$2,000.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,000.70
|
| Rate for Payer: GEHA Commercial |
$1,778.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,000.70
|
| Rate for Payer: Humana ChoiceCare |
$577.98
|
| Rate for Payer: Multiplan All |
$2,022.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,333.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,556.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,000.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,111.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,667.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,956.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$555.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,067.39
|
| Rate for Payer: Zelis Auto |
$889.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,111.50
|
|
|
IMPLT PATELLA ASYMMETRIC A35
|
Facility
|
IP
|
$2,223.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$889.20 |
| Max. Negotiated Rate |
$2,111.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,778.40
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cigna Commercial |
$1,889.55
|
| Rate for Payer: First Health Commercial |
$2,000.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,000.70
|
| Rate for Payer: GEHA Commercial |
$1,556.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,000.70
|
| Rate for Payer: Multiplan All |
$2,022.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,556.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,000.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,111.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,667.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,067.39
|
| Rate for Payer: Zelis Auto |
$889.20
|
|
|
IMPLT PATELLA ASYMMETRIC A38 11MM
|
Facility
|
IP
|
$2,223.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$889.20 |
| Max. Negotiated Rate |
$2,111.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,778.40
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cigna Commercial |
$1,889.55
|
| Rate for Payer: First Health Commercial |
$2,000.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,000.70
|
| Rate for Payer: GEHA Commercial |
$1,556.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,000.70
|
| Rate for Payer: Multiplan All |
$2,022.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,556.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,000.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,111.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,667.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,067.39
|
| Rate for Payer: Zelis Auto |
$889.20
|
|
|
IMPLT PATELLA ASYMMETRIC A38 11MM
|
Facility
|
OP
|
$2,223.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$555.75 |
| Max. Negotiated Rate |
$2,111.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,333.80
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cigna Commercial |
$1,889.55
|
| Rate for Payer: First Health Commercial |
$2,000.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,000.70
|
| Rate for Payer: GEHA Commercial |
$1,778.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,000.70
|
| Rate for Payer: Humana ChoiceCare |
$577.98
|
| Rate for Payer: Multiplan All |
$2,022.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,333.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,556.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,000.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,111.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,667.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,956.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$555.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,067.39
|
| Rate for Payer: Zelis Auto |
$889.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,111.50
|
|
|
IMPLT PATELLA ASYMMETRIC A38MMX11MM
|
Facility
|
IP
|
$2,588.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7009029
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,035.20 |
| Max. Negotiated Rate |
$2,458.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,070.40
|
| Rate for Payer: Cash Price |
$1,552.80
|
| Rate for Payer: Cash Price |
$1,552.80
|
| Rate for Payer: Cigna Commercial |
$2,199.80
|
| Rate for Payer: First Health Commercial |
$2,329.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,329.20
|
| Rate for Payer: GEHA Commercial |
$1,811.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,329.20
|
| Rate for Payer: Multiplan All |
$2,355.08
|
| Rate for Payer: OMNI Networks Commercial |
$1,811.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,329.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,458.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,941.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,406.84
|
| Rate for Payer: Zelis Auto |
$1,035.20
|
|
|
IMPLT PATELLA ASYMMETRIC A38MMX11MM
|
Facility
|
OP
|
$2,588.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7009029
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.00 |
| Max. Negotiated Rate |
$2,458.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,552.80
|
| Rate for Payer: Cash Price |
$1,552.80
|
| Rate for Payer: Cash Price |
$1,552.80
|
| Rate for Payer: Cigna Commercial |
$2,199.80
|
| Rate for Payer: First Health Commercial |
$2,329.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,329.20
|
| Rate for Payer: GEHA Commercial |
$2,070.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,329.20
|
| Rate for Payer: Humana ChoiceCare |
$672.88
|
| Rate for Payer: Multiplan All |
$2,355.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,552.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,811.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,329.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,458.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,941.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,277.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$647.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,406.84
|
| Rate for Payer: Zelis Auto |
$1,035.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,294.00
|
|
|
IMPLT PATELLA ASYMMETRIC A40MMX11MM
|
Facility
|
OP
|
$2,588.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002724
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.00 |
| Max. Negotiated Rate |
$2,458.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,552.80
|
| Rate for Payer: Cash Price |
$1,552.80
|
| Rate for Payer: Cash Price |
$1,552.80
|
| Rate for Payer: Cigna Commercial |
$2,199.80
|
| Rate for Payer: First Health Commercial |
$2,329.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,329.20
|
| Rate for Payer: GEHA Commercial |
$2,070.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,329.20
|
| Rate for Payer: Humana ChoiceCare |
$672.88
|
| Rate for Payer: Multiplan All |
$2,355.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,552.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,811.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,329.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,458.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,941.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,277.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$647.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,406.84
|
| Rate for Payer: Zelis Auto |
$1,035.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,294.00
|
|
|
IMPLT PATELLA ASYMMETRIC A40MMX11MM
|
Facility
|
IP
|
$2,588.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002724
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,035.20 |
| Max. Negotiated Rate |
$2,458.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,070.40
|
| Rate for Payer: Cash Price |
$1,552.80
|
| Rate for Payer: Cash Price |
$1,552.80
|
| Rate for Payer: Cigna Commercial |
$2,199.80
|
| Rate for Payer: First Health Commercial |
$2,329.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,329.20
|
| Rate for Payer: GEHA Commercial |
$1,811.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,329.20
|
| Rate for Payer: Multiplan All |
$2,355.08
|
| Rate for Payer: OMNI Networks Commercial |
$1,811.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,329.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,458.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,941.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,406.84
|
| Rate for Payer: Zelis Auto |
$1,035.20
|
|
|
IMPLT PATELLA ASYMMETRIC CR SZ A40
|
Facility
|
IP
|
$2,223.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003221
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$889.20 |
| Max. Negotiated Rate |
$2,111.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,778.40
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cigna Commercial |
$1,889.55
|
| Rate for Payer: First Health Commercial |
$2,000.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,000.70
|
| Rate for Payer: GEHA Commercial |
$1,556.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,000.70
|
| Rate for Payer: Multiplan All |
$2,022.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,556.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,000.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,111.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,667.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,067.39
|
| Rate for Payer: Zelis Auto |
$889.20
|
|
|
IMPLT PATELLA ASYMMETRIC CR SZ A40
|
Facility
|
OP
|
$2,223.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003221
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$555.75 |
| Max. Negotiated Rate |
$2,111.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,333.80
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cigna Commercial |
$1,889.55
|
| Rate for Payer: First Health Commercial |
$2,000.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,000.70
|
| Rate for Payer: GEHA Commercial |
$1,778.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,000.70
|
| Rate for Payer: Humana ChoiceCare |
$577.98
|
| Rate for Payer: Multiplan All |
$2,022.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,333.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,556.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,000.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,111.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,667.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,956.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$555.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,067.39
|
| Rate for Payer: Zelis Auto |
$889.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,111.50
|
|
|
IMPLT PATELLA ASYMMETRIC SIZE A29
|
Facility
|
IP
|
$2,223.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006639
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$889.20 |
| Max. Negotiated Rate |
$2,111.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,778.40
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cigna Commercial |
$1,889.55
|
| Rate for Payer: First Health Commercial |
$2,000.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,000.70
|
| Rate for Payer: GEHA Commercial |
$1,556.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,000.70
|
| Rate for Payer: Multiplan All |
$2,022.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,556.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,000.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,111.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,667.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,067.39
|
| Rate for Payer: Zelis Auto |
$889.20
|
|
|
IMPLT PATELLA ASYMMETRIC SIZE A29
|
Facility
|
OP
|
$2,223.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006639
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$555.75 |
| Max. Negotiated Rate |
$2,111.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,333.80
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cigna Commercial |
$1,889.55
|
| Rate for Payer: First Health Commercial |
$2,000.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,000.70
|
| Rate for Payer: GEHA Commercial |
$1,778.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,000.70
|
| Rate for Payer: Humana ChoiceCare |
$577.98
|
| Rate for Payer: Multiplan All |
$2,022.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,333.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,556.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,000.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,111.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,667.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,956.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$555.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,067.39
|
| Rate for Payer: Zelis Auto |
$889.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,111.50
|
|
