|
IMPLT RESERVOIR,IZ AMS 700
|
Facility
|
OP
|
$7,141.00
|
|
|
Service Code
|
CPT C1813
|
| Hospital Charge Code |
7002393
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,785.25 |
| Max. Negotiated Rate |
$6,783.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,284.60
|
| Rate for Payer: Cash Price |
$4,284.60
|
| Rate for Payer: Cash Price |
$4,284.60
|
| Rate for Payer: Cigna Commercial |
$6,069.85
|
| Rate for Payer: First Health Commercial |
$6,426.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,426.90
|
| Rate for Payer: GEHA Commercial |
$5,712.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,426.90
|
| Rate for Payer: Humana ChoiceCare |
$1,856.66
|
| Rate for Payer: Multiplan All |
$6,498.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,284.60
|
| Rate for Payer: OMNI Networks Commercial |
$4,998.70
|
| Rate for Payer: One Health Plan PPO/POS |
$6,426.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,783.95
|
| Rate for Payer: Three Rivers Provider Network All |
$5,355.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,284.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,641.13
|
| Rate for Payer: Zelis Auto |
$2,856.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,570.50
|
|
|
IMPLT RESERVOIR,IZ AMS 700
|
Facility
|
IP
|
$7,141.00
|
|
|
Service Code
|
CPT C1813
|
| Hospital Charge Code |
7002393
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,856.40 |
| Max. Negotiated Rate |
$6,783.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,712.80
|
| Rate for Payer: Cash Price |
$4,284.60
|
| Rate for Payer: Cash Price |
$4,284.60
|
| Rate for Payer: Cigna Commercial |
$6,069.85
|
| Rate for Payer: First Health Commercial |
$6,426.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,426.90
|
| Rate for Payer: GEHA Commercial |
$4,998.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,426.90
|
| Rate for Payer: Multiplan All |
$6,498.31
|
| Rate for Payer: OMNI Networks Commercial |
$4,998.70
|
| Rate for Payer: One Health Plan PPO/POS |
$6,426.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,783.95
|
| Rate for Payer: Three Rivers Provider Network All |
$5,355.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,641.13
|
| Rate for Payer: Zelis Auto |
$2,856.40
|
|
|
IMPLT RESERVOIR IZ CONCEAL
|
Facility
|
IP
|
$7,460.00
|
|
|
Service Code
|
CPT C1813
|
| Hospital Charge Code |
7002490
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,984.00 |
| Max. Negotiated Rate |
$7,087.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,968.00
|
| Rate for Payer: Cash Price |
$4,476.00
|
| Rate for Payer: Cash Price |
$4,476.00
|
| Rate for Payer: Cigna Commercial |
$6,341.00
|
| Rate for Payer: First Health Commercial |
$6,714.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,714.00
|
| Rate for Payer: GEHA Commercial |
$5,222.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,714.00
|
| Rate for Payer: Multiplan All |
$6,788.60
|
| Rate for Payer: OMNI Networks Commercial |
$5,222.00
|
| Rate for Payer: One Health Plan PPO/POS |
$6,714.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,087.00
|
| Rate for Payer: Three Rivers Provider Network All |
$5,595.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,937.80
|
| Rate for Payer: Zelis Auto |
$2,984.00
|
|
|
IMPLT RESERVOIR IZ CONCEAL
|
Facility
|
OP
|
$7,460.00
|
|
|
Service Code
|
CPT C1813
|
| Hospital Charge Code |
7002490
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,865.00 |
| Max. Negotiated Rate |
$7,087.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,476.00
|
| Rate for Payer: Cash Price |
$4,476.00
|
| Rate for Payer: Cash Price |
$4,476.00
|
| Rate for Payer: Cigna Commercial |
$6,341.00
|
| Rate for Payer: First Health Commercial |
$6,714.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,714.00
|
| Rate for Payer: GEHA Commercial |
$5,968.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,714.00
|
| Rate for Payer: Humana ChoiceCare |
$1,939.60
|
| Rate for Payer: Multiplan All |
$6,788.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,476.00
|
| Rate for Payer: OMNI Networks Commercial |
$5,222.00
|
| Rate for Payer: One Health Plan PPO/POS |
$6,714.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,087.00
|
| Rate for Payer: Three Rivers Provider Network All |
$5,595.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,564.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,865.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,937.80
|
| Rate for Payer: Zelis Auto |
$2,984.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,730.00
|
|
|
IMPLT RESTORATION HIP STEM 155MM 14MM
|
Facility
|
IP
|
$8,598.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002815
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,439.20 |
| Max. Negotiated Rate |
$8,168.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,878.40
|
| Rate for Payer: Cash Price |
$5,158.80
|
| Rate for Payer: Cash Price |
$5,158.80
|
| Rate for Payer: Cigna Commercial |
$7,308.30
|
| Rate for Payer: First Health Commercial |
$7,738.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,738.20
|
| Rate for Payer: GEHA Commercial |
$6,018.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,738.20
|
| Rate for Payer: Multiplan All |
$7,824.18
|
| Rate for Payer: OMNI Networks Commercial |
$6,018.60
|
| Rate for Payer: One Health Plan PPO/POS |
$7,738.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,168.10
|
| Rate for Payer: Three Rivers Provider Network All |
$6,448.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,996.14
|
| Rate for Payer: Zelis Auto |
$3,439.20
|
|
|
IMPLT RESTORATION HIP STEM 155MM 14MM
|
Facility
|
OP
|
$8,598.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002815
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,149.50 |
| Max. Negotiated Rate |
$8,168.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,158.80
|
| Rate for Payer: Cash Price |
$5,158.80
|
| Rate for Payer: Cash Price |
$5,158.80
|
| Rate for Payer: Cigna Commercial |
$7,308.30
|
| Rate for Payer: First Health Commercial |
$7,738.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,738.20
|
| Rate for Payer: GEHA Commercial |
$6,878.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,738.20
|
| Rate for Payer: Humana ChoiceCare |
$2,235.48
|
| Rate for Payer: Multiplan All |
$7,824.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,158.80
|
| Rate for Payer: OMNI Networks Commercial |
$6,018.60
|
| Rate for Payer: One Health Plan PPO/POS |
$7,738.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,168.10
|
| Rate for Payer: Three Rivers Provider Network All |
$6,448.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,566.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,149.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,996.14
|
| Rate for Payer: Zelis Auto |
$3,439.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,299.00
|
|
|
IMPLT RESTORATION HIP STEM 155MM 15MM
|
Facility
|
IP
|
$9,203.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003330
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,681.20 |
| Max. Negotiated Rate |
$8,742.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7,362.40
|
| Rate for Payer: Cash Price |
$5,521.80
|
| Rate for Payer: Cash Price |
$5,521.80
|
| Rate for Payer: Cigna Commercial |
$7,822.55
|
| Rate for Payer: First Health Commercial |
$8,282.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,282.70
|
| Rate for Payer: GEHA Commercial |
$6,442.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,282.70
|
| Rate for Payer: Multiplan All |
$8,374.73
|
| Rate for Payer: OMNI Networks Commercial |
$6,442.10
|
| Rate for Payer: One Health Plan PPO/POS |
$8,282.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,742.85
|
| Rate for Payer: Three Rivers Provider Network All |
$6,902.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,558.79
|
| Rate for Payer: Zelis Auto |
$3,681.20
|
|
|
IMPLT RESTORATION HIP STEM 155MM 15MM
|
Facility
|
OP
|
$9,203.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003330
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,300.75 |
| Max. Negotiated Rate |
$8,742.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,521.80
|
| Rate for Payer: Cash Price |
$5,521.80
|
| Rate for Payer: Cash Price |
$5,521.80
|
| Rate for Payer: Cigna Commercial |
$7,822.55
|
| Rate for Payer: First Health Commercial |
$8,282.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,282.70
|
| Rate for Payer: GEHA Commercial |
$7,362.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,282.70
|
| Rate for Payer: Humana ChoiceCare |
$2,392.78
|
| Rate for Payer: Multiplan All |
$8,374.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,521.80
|
| Rate for Payer: OMNI Networks Commercial |
$6,442.10
|
| Rate for Payer: One Health Plan PPO/POS |
$8,282.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,742.85
|
| Rate for Payer: Three Rivers Provider Network All |
$6,902.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8,098.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,300.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,558.79
|
| Rate for Payer: Zelis Auto |
$3,681.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,601.50
|
|
|
IMPLT RESTORATION HIP STEM 155MM 16MM
|
Facility
|
IP
|
$8,468.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7008007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,387.20 |
| Max. Negotiated Rate |
$8,044.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,774.40
|
| Rate for Payer: Cash Price |
$5,080.80
|
| Rate for Payer: Cash Price |
$5,080.80
|
| Rate for Payer: Cigna Commercial |
$7,197.80
|
| Rate for Payer: First Health Commercial |
$7,621.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,621.20
|
| Rate for Payer: GEHA Commercial |
$5,927.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,621.20
|
| Rate for Payer: Multiplan All |
$7,705.88
|
| Rate for Payer: OMNI Networks Commercial |
$5,927.60
|
| Rate for Payer: One Health Plan PPO/POS |
$7,621.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,044.60
|
| Rate for Payer: Three Rivers Provider Network All |
$6,351.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,875.24
|
| Rate for Payer: Zelis Auto |
$3,387.20
|
|
|
IMPLT RESTORATION HIP STEM 155MM 16MM
|
Facility
|
OP
|
$8,468.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7008007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,117.00 |
| Max. Negotiated Rate |
$8,044.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,080.80
|
| Rate for Payer: Cash Price |
$5,080.80
|
| Rate for Payer: Cash Price |
$5,080.80
|
| Rate for Payer: Cigna Commercial |
$7,197.80
|
| Rate for Payer: First Health Commercial |
$7,621.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,621.20
|
| Rate for Payer: GEHA Commercial |
$6,774.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,621.20
|
| Rate for Payer: Humana ChoiceCare |
$2,201.68
|
| Rate for Payer: Multiplan All |
$7,705.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,080.80
|
| Rate for Payer: OMNI Networks Commercial |
$5,927.60
|
| Rate for Payer: One Health Plan PPO/POS |
$7,621.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,044.60
|
| Rate for Payer: Three Rivers Provider Network All |
$6,351.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,451.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,117.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,875.24
|
| Rate for Payer: Zelis Auto |
$3,387.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,234.00
|
|
|
IMPLT RESTORATION MOD HIP STEM155MM 17MM
|
Facility
|
OP
|
$9,440.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003128
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,360.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,664.00
|
| Rate for Payer: Cash Price |
$5,664.00
|
| Rate for Payer: Cash Price |
$5,664.00
|
| Rate for Payer: Cigna Commercial |
$8,024.00
|
| Rate for Payer: First Health Commercial |
$8,496.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,496.00
|
| Rate for Payer: GEHA Commercial |
$7,552.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,496.00
|
| Rate for Payer: Humana ChoiceCare |
$2,454.40
|
| Rate for Payer: Multiplan All |
$8,590.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,664.00
|
| Rate for Payer: OMNI Networks Commercial |
$6,608.00
|
| Rate for Payer: One Health Plan PPO/POS |
$8,496.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,968.00
|
| Rate for Payer: Three Rivers Provider Network All |
$7,080.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8,307.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,360.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,779.20
|
| Rate for Payer: Zelis Auto |
$3,776.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,720.00
|
|
|
IMPLT RESTORATION MOD HIP STEM155MM 17MM
|
Facility
|
IP
|
$9,440.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003128
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,776.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7,552.00
|
| Rate for Payer: Cash Price |
$5,664.00
|
| Rate for Payer: Cash Price |
$5,664.00
|
| Rate for Payer: Cigna Commercial |
$8,024.00
|
| Rate for Payer: First Health Commercial |
$8,496.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,496.00
|
| Rate for Payer: GEHA Commercial |
$6,608.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,496.00
|
| Rate for Payer: Multiplan All |
$8,590.40
|
| Rate for Payer: OMNI Networks Commercial |
$6,608.00
|
| Rate for Payer: One Health Plan PPO/POS |
$8,496.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,968.00
|
| Rate for Payer: Three Rivers Provider Network All |
$7,080.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,779.20
|
| Rate for Payer: Zelis Auto |
$3,776.00
|
|
|
IMPLT RESTORATION MOD HIP STEM155MM 18MM
|
Facility
|
OP
|
$8,581.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002271
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,145.25 |
| Max. Negotiated Rate |
$8,151.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,148.60
|
| Rate for Payer: Cash Price |
$5,148.60
|
| Rate for Payer: Cash Price |
$5,148.60
|
| Rate for Payer: Cigna Commercial |
$7,293.85
|
| Rate for Payer: First Health Commercial |
$7,722.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,722.90
|
| Rate for Payer: GEHA Commercial |
$6,864.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,722.90
|
| Rate for Payer: Humana ChoiceCare |
$2,231.06
|
| Rate for Payer: Multiplan All |
$7,808.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,148.60
|
| Rate for Payer: OMNI Networks Commercial |
$6,006.70
|
| Rate for Payer: One Health Plan PPO/POS |
$7,722.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,151.95
|
| Rate for Payer: Three Rivers Provider Network All |
$6,435.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,551.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,145.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,980.33
|
| Rate for Payer: Zelis Auto |
$3,432.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,290.50
|
|
|
IMPLT RESTORATION MOD HIP STEM155MM 18MM
|
Facility
|
IP
|
$8,581.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002271
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,432.40 |
| Max. Negotiated Rate |
$8,151.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,864.80
|
| Rate for Payer: Cash Price |
$5,148.60
|
| Rate for Payer: Cash Price |
$5,148.60
|
| Rate for Payer: Cigna Commercial |
$7,293.85
|
| Rate for Payer: First Health Commercial |
$7,722.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,722.90
|
| Rate for Payer: GEHA Commercial |
$6,006.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,722.90
|
| Rate for Payer: Multiplan All |
$7,808.71
|
| Rate for Payer: OMNI Networks Commercial |
$6,006.70
|
| Rate for Payer: One Health Plan PPO/POS |
$7,722.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,151.95
|
| Rate for Payer: Three Rivers Provider Network All |
$6,435.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,980.33
|
| Rate for Payer: Zelis Auto |
$3,432.40
|
|
|
IMPLT RESTORATION MOD HIP STEM 21MM 30MM
|
Facility
|
IP
|
$8,468.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7008005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,387.20 |
| Max. Negotiated Rate |
$8,044.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,774.40
|
| Rate for Payer: Cash Price |
$5,080.80
|
| Rate for Payer: Cash Price |
$5,080.80
|
| Rate for Payer: Cigna Commercial |
$7,197.80
|
| Rate for Payer: First Health Commercial |
$7,621.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,621.20
|
| Rate for Payer: GEHA Commercial |
$5,927.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,621.20
|
| Rate for Payer: Multiplan All |
$7,705.88
|
| Rate for Payer: OMNI Networks Commercial |
$5,927.60
|
| Rate for Payer: One Health Plan PPO/POS |
$7,621.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,044.60
|
| Rate for Payer: Three Rivers Provider Network All |
$6,351.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,875.24
|
| Rate for Payer: Zelis Auto |
$3,387.20
|
|
|
IMPLT RESTORATION MOD HIP STEM 21MM 30MM
|
Facility
|
OP
|
$8,468.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7008005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,117.00 |
| Max. Negotiated Rate |
$8,044.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,080.80
|
| Rate for Payer: Cash Price |
$5,080.80
|
| Rate for Payer: Cash Price |
$5,080.80
|
| Rate for Payer: Cigna Commercial |
$7,197.80
|
| Rate for Payer: First Health Commercial |
$7,621.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,621.20
|
| Rate for Payer: GEHA Commercial |
$6,774.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,621.20
|
| Rate for Payer: Humana ChoiceCare |
$2,201.68
|
| Rate for Payer: Multiplan All |
$7,705.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,080.80
|
| Rate for Payer: OMNI Networks Commercial |
$5,927.60
|
| Rate for Payer: One Health Plan PPO/POS |
$7,621.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,044.60
|
| Rate for Payer: Three Rivers Provider Network All |
$6,351.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,451.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,117.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,875.24
|
| Rate for Payer: Zelis Auto |
$3,387.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,234.00
|
|
|
IMPLT RESTORATION MOD HIP SYSTEM 19MM
|
Facility
|
OP
|
$11,699.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002838
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,924.75 |
| Max. Negotiated Rate |
$11,114.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7,019.40
|
| Rate for Payer: Cash Price |
$7,019.40
|
| Rate for Payer: Cash Price |
$7,019.40
|
| Rate for Payer: Cigna Commercial |
$9,944.15
|
| Rate for Payer: First Health Commercial |
$10,529.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10,529.10
|
| Rate for Payer: GEHA Commercial |
$9,359.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10,529.10
|
| Rate for Payer: Humana ChoiceCare |
$3,041.74
|
| Rate for Payer: Multiplan All |
$10,646.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7,019.40
|
| Rate for Payer: OMNI Networks Commercial |
$8,189.30
|
| Rate for Payer: One Health Plan PPO/POS |
$10,529.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$11,114.05
|
| Rate for Payer: Three Rivers Provider Network All |
$8,774.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10,295.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,924.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$10,880.07
|
| Rate for Payer: Zelis Auto |
$4,679.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,849.50
|
|
|
IMPLT RESTORATION MOD HIP SYSTEM 19MM
|
Facility
|
IP
|
$11,699.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002838
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,679.60 |
| Max. Negotiated Rate |
$11,114.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9,359.20
|
| Rate for Payer: Cash Price |
$7,019.40
|
| Rate for Payer: Cash Price |
$7,019.40
|
| Rate for Payer: Cigna Commercial |
$9,944.15
|
| Rate for Payer: First Health Commercial |
$10,529.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10,529.10
|
| Rate for Payer: GEHA Commercial |
$8,189.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10,529.10
|
| Rate for Payer: Multiplan All |
$10,646.09
|
| Rate for Payer: OMNI Networks Commercial |
$8,189.30
|
| Rate for Payer: One Health Plan PPO/POS |
$10,529.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$11,114.05
|
| Rate for Payer: Three Rivers Provider Network All |
$8,774.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$10,880.07
|
| Rate for Payer: Zelis Auto |
$4,679.60
|
|
|
IMPLT RESTORATION MODULAR HIP 23MM+0 V40
|
Facility
|
IP
|
$12,544.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002270
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,017.60 |
| Max. Negotiated Rate |
$11,916.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$10,035.20
|
| Rate for Payer: Cash Price |
$7,526.40
|
| Rate for Payer: Cash Price |
$7,526.40
|
| Rate for Payer: Cigna Commercial |
$10,662.40
|
| Rate for Payer: First Health Commercial |
$11,289.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$11,289.60
|
| Rate for Payer: GEHA Commercial |
$8,780.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$11,289.60
|
| Rate for Payer: Multiplan All |
$11,415.04
|
| Rate for Payer: OMNI Networks Commercial |
$8,780.80
|
| Rate for Payer: One Health Plan PPO/POS |
$11,289.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$11,916.80
|
| Rate for Payer: Three Rivers Provider Network All |
$9,408.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$11,665.92
|
| Rate for Payer: Zelis Auto |
$5,017.60
|
|
|
IMPLT RESTORATION MODULAR HIP 23MM+0 V40
|
Facility
|
OP
|
$12,544.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002270
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,136.00 |
| Max. Negotiated Rate |
$11,916.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7,526.40
|
| Rate for Payer: Cash Price |
$7,526.40
|
| Rate for Payer: Cash Price |
$7,526.40
|
| Rate for Payer: Cigna Commercial |
$10,662.40
|
| Rate for Payer: First Health Commercial |
$11,289.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$11,289.60
|
| Rate for Payer: GEHA Commercial |
$10,035.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$11,289.60
|
| Rate for Payer: Humana ChoiceCare |
$3,261.44
|
| Rate for Payer: Multiplan All |
$11,415.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7,526.40
|
| Rate for Payer: OMNI Networks Commercial |
$8,780.80
|
| Rate for Payer: One Health Plan PPO/POS |
$11,289.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$11,916.80
|
| Rate for Payer: Three Rivers Provider Network All |
$9,408.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,038.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,136.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$11,665.92
|
| Rate for Payer: Zelis Auto |
$5,017.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,272.00
|
|
|
IMPLT RETRIEVER SUTURE 3.4MM STRAIGH
|
Facility
|
IP
|
$3,882.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
7001783
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,552.80 |
| Max. Negotiated Rate |
$3,687.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,105.60
|
| Rate for Payer: Cash Price |
$2,329.20
|
| Rate for Payer: Cash Price |
$2,329.20
|
| Rate for Payer: Cigna Commercial |
$3,299.70
|
| Rate for Payer: First Health Commercial |
$3,493.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,493.80
|
| Rate for Payer: GEHA Commercial |
$2,717.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,493.80
|
| Rate for Payer: Multiplan All |
$3,532.62
|
| Rate for Payer: OMNI Networks Commercial |
$2,717.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,493.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,687.90
|
| Rate for Payer: Three Rivers Provider Network All |
$2,911.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,610.26
|
| Rate for Payer: Zelis Auto |
$1,552.80
|
|
|
IMPLT RETRIEVER SUTURE 3.4MM STRAIGH
|
Facility
|
OP
|
$3,882.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
7001783
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$970.50 |
| Max. Negotiated Rate |
$3,687.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,329.20
|
| Rate for Payer: Cash Price |
$2,329.20
|
| Rate for Payer: Cash Price |
$2,329.20
|
| Rate for Payer: Cigna Commercial |
$3,299.70
|
| Rate for Payer: First Health Commercial |
$3,493.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,493.80
|
| Rate for Payer: GEHA Commercial |
$3,105.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,493.80
|
| Rate for Payer: Humana ChoiceCare |
$1,009.32
|
| Rate for Payer: Multiplan All |
$3,532.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,329.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,717.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,493.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,687.90
|
| Rate for Payer: Three Rivers Provider Network All |
$2,911.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,416.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$970.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,610.26
|
| Rate for Payer: Zelis Auto |
$1,552.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,941.00
|
|
|
IMPLT ROD 65MM
|
Facility
|
OP
|
$1,407.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000431
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$351.75 |
| Max. Negotiated Rate |
$1,336.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$844.20
|
| Rate for Payer: Cash Price |
$844.20
|
| Rate for Payer: Cash Price |
$844.20
|
| Rate for Payer: Cigna Commercial |
$1,195.95
|
| Rate for Payer: First Health Commercial |
$1,266.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,266.30
|
| Rate for Payer: GEHA Commercial |
$1,125.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,266.30
|
| Rate for Payer: Humana ChoiceCare |
$365.82
|
| Rate for Payer: Multiplan All |
$1,280.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$844.20
|
| Rate for Payer: OMNI Networks Commercial |
$984.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,266.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,336.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,055.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,238.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$351.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,308.51
|
| Rate for Payer: Zelis Auto |
$562.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$703.50
|
|
|
IMPLT ROD 65MM
|
Facility
|
IP
|
$1,407.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000431
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$562.80 |
| Max. Negotiated Rate |
$1,336.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,125.60
|
| Rate for Payer: Cash Price |
$844.20
|
| Rate for Payer: Cash Price |
$844.20
|
| Rate for Payer: Cigna Commercial |
$1,195.95
|
| Rate for Payer: First Health Commercial |
$1,266.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,266.30
|
| Rate for Payer: GEHA Commercial |
$984.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,266.30
|
| Rate for Payer: Multiplan All |
$1,280.37
|
| Rate for Payer: OMNI Networks Commercial |
$984.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,266.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,336.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,055.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,308.51
|
| Rate for Payer: Zelis Auto |
$562.80
|
|
|
IMPLT ROD 8MM X 350MM
|
Facility
|
OP
|
$1,472.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000433
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$368.00 |
| Max. Negotiated Rate |
$1,398.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$883.20
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cigna Commercial |
$1,251.20
|
| Rate for Payer: First Health Commercial |
$1,324.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,324.80
|
| Rate for Payer: GEHA Commercial |
$1,177.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,324.80
|
| Rate for Payer: Humana ChoiceCare |
$382.72
|
| Rate for Payer: Multiplan All |
$1,339.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$883.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,030.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,324.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,398.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,104.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,295.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$368.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,368.96
|
| Rate for Payer: Zelis Auto |
$588.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$736.00
|
|
