|
IMPLT PATELLA SYMMETRIC SIZE29MM 8MM
|
Facility
|
IP
|
$2,223.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006188
|
|
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 SYMMETRIC SIZE33 9MM
|
Facility
|
OP
|
$2,223.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002104
|
|
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 SYMMETRIC SIZE33 9MM
|
Facility
|
IP
|
$2,223.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002104
|
|
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 SYMMETRIC SIZE S39MM/11MM
|
Facility
|
IP
|
$2,223.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002107
|
|
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 SYMMETRIC SIZE S39MM/11MM
|
Facility
|
OP
|
$2,223.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002107
|
|
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 SYMMETRIC TRIATHLON 29X8MM
|
Facility
|
OP
|
$2,223.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7007056
|
|
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 SYMMETRIC TRIATHLON 29X8MM
|
Facility
|
IP
|
$2,223.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7007056
|
|
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 SYMMETRIC TRIATHLON 31X9MM
|
Facility
|
IP
|
$2,223.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002105
|
|
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 SYMMETRIC TRIATHLON 31X9MM
|
Facility
|
IP
|
$2,223.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7007014
|
|
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 SYMMETRIC TRIATHLON 31X9MM
|
Facility
|
OP
|
$2,223.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002105
|
|
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 SYMMETRIC TRIATHLON 31X9MM
|
Facility
|
OP
|
$2,223.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7007014
|
|
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 SYMMETRIC TRIATHLON 33X9MM
|
Facility
|
OP
|
$2,223.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006656
|
|
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 SYMMETRIC TRIATHLON 33X9MM
|
Facility
|
IP
|
$2,223.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006656
|
|
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 SYMMETRIC TRIATH S36MM 10M
|
Facility
|
IP
|
$2,223.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003237
|
|
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 SYMMETRIC TRIATH S36MM 10M
|
Facility
|
OP
|
$2,223.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003237
|
|
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 SYMMETRIC TRI SZ 39MM/11MM
|
Facility
|
IP
|
$2,223.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003238
|
|
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 SYMMETRIC TRI SZ 39MM/11MM
|
Facility
|
OP
|
$2,223.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003238
|
|
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 SYMMETRIC X3 SIZE33 9MM
|
Facility
|
IP
|
$2,223.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003216
|
|
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 SYMMETRIC X3 SIZE33 9MM
|
Facility
|
OP
|
$2,223.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003216
|
|
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 TRIATHLON SIZES36MM
|
Facility
|
OP
|
$2,223.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002106
|
|
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 TRIATHLON SIZES36MM
|
Facility
|
IP
|
$2,223.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002106
|
|
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 PEG FEMORAL DISTAL FIXATION
|
Facility
|
OP
|
$1,723.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002114
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$430.75 |
| Max. Negotiated Rate |
$1,636.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,033.80
|
| Rate for Payer: Cash Price |
$1,033.80
|
| Rate for Payer: Cash Price |
$1,033.80
|
| Rate for Payer: Cigna Commercial |
$1,464.55
|
| Rate for Payer: First Health Commercial |
$1,550.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,550.70
|
| Rate for Payer: GEHA Commercial |
$1,378.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,550.70
|
| Rate for Payer: Humana ChoiceCare |
$447.98
|
| Rate for Payer: Multiplan All |
$1,567.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,033.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,206.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,550.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,636.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,292.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,516.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$430.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,602.39
|
| Rate for Payer: Zelis Auto |
$689.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$861.50
|
|
|
IMPLT PEG FEMORAL DISTAL FIXATION
|
Facility
|
IP
|
$1,723.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002114
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$689.20 |
| Max. Negotiated Rate |
$1,636.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,378.40
|
| Rate for Payer: Cash Price |
$1,033.80
|
| Rate for Payer: Cash Price |
$1,033.80
|
| Rate for Payer: Cigna Commercial |
$1,464.55
|
| Rate for Payer: First Health Commercial |
$1,550.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,550.70
|
| Rate for Payer: GEHA Commercial |
$1,206.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,550.70
|
| Rate for Payer: Multiplan All |
$1,567.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,206.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,550.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,636.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,292.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,602.39
|
| Rate for Payer: Zelis Auto |
$689.20
|
|
|
IMPLT PEG LOCKING 2.0
|
Facility
|
OP
|
$871.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006441
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$217.75 |
| Max. Negotiated Rate |
$827.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$522.60
|
| Rate for Payer: Cash Price |
$522.60
|
| Rate for Payer: Cash Price |
$522.60
|
| Rate for Payer: Cigna Commercial |
$740.35
|
| Rate for Payer: First Health Commercial |
$783.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$783.90
|
| Rate for Payer: GEHA Commercial |
$696.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$783.90
|
| Rate for Payer: Humana ChoiceCare |
$226.46
|
| Rate for Payer: Multiplan All |
$792.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$522.60
|
| Rate for Payer: OMNI Networks Commercial |
$609.70
|
| Rate for Payer: One Health Plan PPO/POS |
$783.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$827.45
|
| Rate for Payer: Three Rivers Provider Network All |
$653.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$766.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$217.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$810.03
|
| Rate for Payer: Zelis Auto |
$348.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$435.50
|
|
|
IMPLT PEG LOCKING 2.0
|
Facility
|
IP
|
$871.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006441
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$348.40 |
| Max. Negotiated Rate |
$827.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$696.80
|
| Rate for Payer: Cash Price |
$522.60
|
| Rate for Payer: Cash Price |
$522.60
|
| Rate for Payer: Cigna Commercial |
$740.35
|
| Rate for Payer: First Health Commercial |
$783.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$783.90
|
| Rate for Payer: GEHA Commercial |
$609.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$783.90
|
| Rate for Payer: Multiplan All |
$792.61
|
| Rate for Payer: OMNI Networks Commercial |
$609.70
|
| Rate for Payer: One Health Plan PPO/POS |
$783.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$827.45
|
| Rate for Payer: Three Rivers Provider Network All |
$653.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$810.03
|
| Rate for Payer: Zelis Auto |
$348.40
|
|
