|
IMPLT SHEATH INTRODUCER FLEX G07856
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
7002423
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.20 |
| Max. Negotiated Rate |
$330.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$278.40
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cigna Commercial |
$295.80
|
| Rate for Payer: First Health Commercial |
$313.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$313.20
|
| Rate for Payer: GEHA Commercial |
$243.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$313.20
|
| Rate for Payer: Multiplan All |
$316.68
|
| Rate for Payer: OMNI Networks Commercial |
$243.60
|
| Rate for Payer: One Health Plan PPO/POS |
$313.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$330.60
|
| Rate for Payer: Three Rivers Provider Network All |
$261.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$323.64
|
| Rate for Payer: Zelis Auto |
$139.20
|
|
|
IMPLT SHEATH INTRODUCER FLEX G07856
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
7002423
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$330.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cigna Commercial |
$295.80
|
| Rate for Payer: First Health Commercial |
$313.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$313.20
|
| Rate for Payer: GEHA Commercial |
$278.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$313.20
|
| Rate for Payer: Humana ChoiceCare |
$90.48
|
| Rate for Payer: Multiplan All |
$316.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.80
|
| Rate for Payer: OMNI Networks Commercial |
$243.60
|
| Rate for Payer: One Health Plan PPO/POS |
$313.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$330.60
|
| Rate for Payer: Three Rivers Provider Network All |
$261.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$306.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$87.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$323.64
|
| Rate for Payer: Zelis Auto |
$139.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$174.00
|
|
|
IMPLT SHEATH INTRODUCER FLEX G08867
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
7002424
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$72.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$76.50
|
| Rate for Payer: First Health Commercial |
$81.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$81.00
|
| Rate for Payer: GEHA Commercial |
$63.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$81.00
|
| Rate for Payer: Multiplan All |
$81.90
|
| Rate for Payer: OMNI Networks Commercial |
$63.00
|
| Rate for Payer: One Health Plan PPO/POS |
$81.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$85.50
|
| Rate for Payer: Three Rivers Provider Network All |
$67.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$83.70
|
| Rate for Payer: Zelis Auto |
$36.00
|
|
|
IMPLT SHEATH INTRODUCER FLEX G08867
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
7002424
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$76.50
|
| Rate for Payer: First Health Commercial |
$81.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$81.00
|
| Rate for Payer: GEHA Commercial |
$72.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$81.00
|
| Rate for Payer: Humana ChoiceCare |
$23.40
|
| Rate for Payer: Multiplan All |
$81.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$54.00
|
| Rate for Payer: OMNI Networks Commercial |
$63.00
|
| Rate for Payer: One Health Plan PPO/POS |
$81.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$85.50
|
| Rate for Payer: Three Rivers Provider Network All |
$67.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$79.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$22.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$83.70
|
| Rate for Payer: Zelis Auto |
$36.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$45.00
|
|
|
IMPLT SHELL 3 HOLE 30MM
|
Facility
|
OP
|
$3,350.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002274
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$837.50 |
| Max. Negotiated Rate |
$3,182.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,010.00
|
| Rate for Payer: Cash Price |
$2,010.00
|
| Rate for Payer: Cash Price |
$2,010.00
|
| Rate for Payer: Cigna Commercial |
$2,847.50
|
| Rate for Payer: First Health Commercial |
$3,015.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,015.00
|
| Rate for Payer: GEHA Commercial |
$2,680.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,015.00
|
| Rate for Payer: Humana ChoiceCare |
$871.00
|
| Rate for Payer: Multiplan All |
$3,048.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,010.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,345.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,015.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,182.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,512.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,948.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$837.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,115.50
|
| Rate for Payer: Zelis Auto |
$1,340.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,675.00
|
|
|
IMPLT SHELL 3 HOLE 30MM
|
Facility
|
IP
|
$3,350.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002274
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,340.00 |
| Max. Negotiated Rate |
$3,182.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,680.00
|
| Rate for Payer: Cash Price |
$2,010.00
|
| Rate for Payer: Cash Price |
$2,010.00
|
| Rate for Payer: Cigna Commercial |
$2,847.50
|
| Rate for Payer: First Health Commercial |
$3,015.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,015.00
|
| Rate for Payer: GEHA Commercial |
$2,345.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,015.00
|
| Rate for Payer: Multiplan All |
$3,048.50
|
| Rate for Payer: OMNI Networks Commercial |
$2,345.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,015.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,182.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,512.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,115.50
|
| Rate for Payer: Zelis Auto |
$1,340.00
|
|
|
IMPLT SHELL 3 HOLE ACETABULAR
|
Facility
|
IP
|
$3,350.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002272
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,340.00 |
| Max. Negotiated Rate |
$3,182.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,680.00
|
| Rate for Payer: Cash Price |
$2,010.00
|
| Rate for Payer: Cash Price |
$2,010.00
|
| Rate for Payer: Cigna Commercial |
$2,847.50
|
| Rate for Payer: First Health Commercial |
$3,015.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,015.00
|
| Rate for Payer: GEHA Commercial |
$2,345.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,015.00
|
| Rate for Payer: Multiplan All |
$3,048.50
|
| Rate for Payer: OMNI Networks Commercial |
$2,345.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,015.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,182.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,512.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,115.50
|
| Rate for Payer: Zelis Auto |
$1,340.00
|
|
|
IMPLT SHELL 3 HOLE ACETABULAR
|
Facility
|
OP
|
$3,350.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002272
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$837.50 |
| Max. Negotiated Rate |
$3,182.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,010.00
|
| Rate for Payer: Cash Price |
$2,010.00
|
| Rate for Payer: Cash Price |
$2,010.00
|
| Rate for Payer: Cigna Commercial |
$2,847.50
|
| Rate for Payer: First Health Commercial |
$3,015.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,015.00
|
| Rate for Payer: GEHA Commercial |
$2,680.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,015.00
|
| Rate for Payer: Humana ChoiceCare |
$871.00
|
| Rate for Payer: Multiplan All |
$3,048.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,010.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,345.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,015.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,182.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,512.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,948.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$837.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,115.50
|
| Rate for Payer: Zelis Auto |
$1,340.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,675.00
|
|
|
IMPLT SHELL 3 HOLE ACETABULAR 60MM
|
Facility
|
OP
|
$3,350.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002273
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$837.50 |
| Max. Negotiated Rate |
$3,182.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,010.00
|
| Rate for Payer: Cash Price |
$2,010.00
|
| Rate for Payer: Cash Price |
$2,010.00
|
| Rate for Payer: Cigna Commercial |
$2,847.50
|
| Rate for Payer: First Health Commercial |
$3,015.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,015.00
|
| Rate for Payer: GEHA Commercial |
$2,680.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,015.00
|
| Rate for Payer: Humana ChoiceCare |
$871.00
|
| Rate for Payer: Multiplan All |
$3,048.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,010.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,345.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,015.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,182.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,512.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,948.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$837.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,115.50
|
| Rate for Payer: Zelis Auto |
$1,340.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,675.00
|
|
|
IMPLT SHELL 3 HOLE ACETABULAR 60MM
|
Facility
|
IP
|
$3,350.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002273
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,340.00 |
| Max. Negotiated Rate |
$3,182.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,680.00
|
| Rate for Payer: Cash Price |
$2,010.00
|
| Rate for Payer: Cash Price |
$2,010.00
|
| Rate for Payer: Cigna Commercial |
$2,847.50
|
| Rate for Payer: First Health Commercial |
$3,015.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,015.00
|
| Rate for Payer: GEHA Commercial |
$2,345.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,015.00
|
| Rate for Payer: Multiplan All |
$3,048.50
|
| Rate for Payer: OMNI Networks Commercial |
$2,345.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,015.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,182.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,512.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,115.50
|
| Rate for Payer: Zelis Auto |
$1,340.00
|
|
|
IMPLT SHELL ACETABULAR
|
Facility
|
OP
|
$4,111.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
70090040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,027.75 |
| Max. Negotiated Rate |
$3,905.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,466.60
|
| Rate for Payer: Cash Price |
$2,466.60
|
| Rate for Payer: Cash Price |
$2,466.60
|
| Rate for Payer: Cigna Commercial |
$3,494.35
|
| Rate for Payer: First Health Commercial |
$3,699.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,699.90
|
| Rate for Payer: GEHA Commercial |
$3,288.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,699.90
|
| Rate for Payer: Humana ChoiceCare |
$1,068.86
|
| Rate for Payer: Multiplan All |
$3,741.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,466.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,877.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,699.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,905.45
|
| Rate for Payer: Three Rivers Provider Network All |
$3,083.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,617.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,027.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,823.23
|
| Rate for Payer: Zelis Auto |
$1,644.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,055.50
|
|
|
IMPLT SHELL ACETABULAR
|
Facility
|
IP
|
$4,111.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
70090040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,644.40 |
| Max. Negotiated Rate |
$3,905.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,288.80
|
| Rate for Payer: Cash Price |
$2,466.60
|
| Rate for Payer: Cash Price |
$2,466.60
|
| Rate for Payer: Cigna Commercial |
$3,494.35
|
| Rate for Payer: First Health Commercial |
$3,699.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,699.90
|
| Rate for Payer: GEHA Commercial |
$2,877.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,699.90
|
| Rate for Payer: Multiplan All |
$3,741.01
|
| Rate for Payer: OMNI Networks Commercial |
$2,877.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,699.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,905.45
|
| Rate for Payer: Three Rivers Provider Network All |
$3,083.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,823.23
|
| Rate for Payer: Zelis Auto |
$1,644.40
|
|
|
IMPLT SHELL ACETABULAR 3 HOLE 46MM
|
Facility
|
OP
|
$432.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002277
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$410.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$259.20
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cigna Commercial |
$367.20
|
| Rate for Payer: First Health Commercial |
$388.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$388.80
|
| Rate for Payer: GEHA Commercial |
$345.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$388.80
|
| Rate for Payer: Humana ChoiceCare |
$112.32
|
| Rate for Payer: Multiplan All |
$393.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$259.20
|
| Rate for Payer: OMNI Networks Commercial |
$302.40
|
| Rate for Payer: One Health Plan PPO/POS |
$388.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$410.40
|
| Rate for Payer: Three Rivers Provider Network All |
$324.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$380.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$108.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$401.76
|
| Rate for Payer: Zelis Auto |
$172.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$216.00
|
|
|
IMPLT SHELL ACETABULAR 3 HOLE 46MM
|
Facility
|
IP
|
$432.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002277
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$172.80 |
| Max. Negotiated Rate |
$410.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$345.60
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cigna Commercial |
$367.20
|
| Rate for Payer: First Health Commercial |
$388.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$388.80
|
| Rate for Payer: GEHA Commercial |
$302.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$388.80
|
| Rate for Payer: Multiplan All |
$393.12
|
| Rate for Payer: OMNI Networks Commercial |
$302.40
|
| Rate for Payer: One Health Plan PPO/POS |
$388.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$410.40
|
| Rate for Payer: Three Rivers Provider Network All |
$324.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$401.76
|
| Rate for Payer: Zelis Auto |
$172.80
|
|
|
IMPLT SHELL ACETABULAR 3 HOLE 50MM
|
Facility
|
IP
|
$3,350.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002140
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,340.00 |
| Max. Negotiated Rate |
$3,182.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,680.00
|
| Rate for Payer: Cash Price |
$2,010.00
|
| Rate for Payer: Cash Price |
$2,010.00
|
| Rate for Payer: Cigna Commercial |
$2,847.50
|
| Rate for Payer: First Health Commercial |
$3,015.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,015.00
|
| Rate for Payer: GEHA Commercial |
$2,345.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,015.00
|
| Rate for Payer: Multiplan All |
$3,048.50
|
| Rate for Payer: OMNI Networks Commercial |
$2,345.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,015.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,182.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,512.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,115.50
|
| Rate for Payer: Zelis Auto |
$1,340.00
|
|
|
IMPLT SHELL ACETABULAR 3 HOLE 50MM
|
Facility
|
OP
|
$3,350.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002140
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$837.50 |
| Max. Negotiated Rate |
$3,182.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,010.00
|
| Rate for Payer: Cash Price |
$2,010.00
|
| Rate for Payer: Cash Price |
$2,010.00
|
| Rate for Payer: Cigna Commercial |
$2,847.50
|
| Rate for Payer: First Health Commercial |
$3,015.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,015.00
|
| Rate for Payer: GEHA Commercial |
$2,680.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,015.00
|
| Rate for Payer: Humana ChoiceCare |
$871.00
|
| Rate for Payer: Multiplan All |
$3,048.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,010.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,345.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,015.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,182.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,512.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,948.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$837.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,115.50
|
| Rate for Payer: Zelis Auto |
$1,340.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,675.00
|
|
|
IMPLT SHELL ACETABULAR 44MM
|
Facility
|
IP
|
$5,296.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002573
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,118.40 |
| Max. Negotiated Rate |
$5,031.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,236.80
|
| Rate for Payer: Cash Price |
$3,177.60
|
| Rate for Payer: Cash Price |
$3,177.60
|
| Rate for Payer: Cigna Commercial |
$4,501.60
|
| Rate for Payer: First Health Commercial |
$4,766.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,766.40
|
| Rate for Payer: GEHA Commercial |
$3,707.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,766.40
|
| Rate for Payer: Multiplan All |
$4,819.36
|
| Rate for Payer: OMNI Networks Commercial |
$3,707.20
|
| Rate for Payer: One Health Plan PPO/POS |
$4,766.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,031.20
|
| Rate for Payer: Three Rivers Provider Network All |
$3,972.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,925.28
|
| Rate for Payer: Zelis Auto |
$2,118.40
|
|
|
IMPLT SHELL ACETABULAR 44MM
|
Facility
|
OP
|
$5,296.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002573
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,324.00 |
| Max. Negotiated Rate |
$5,031.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,177.60
|
| Rate for Payer: Cash Price |
$3,177.60
|
| Rate for Payer: Cash Price |
$3,177.60
|
| Rate for Payer: Cigna Commercial |
$4,501.60
|
| Rate for Payer: First Health Commercial |
$4,766.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,766.40
|
| Rate for Payer: GEHA Commercial |
$4,236.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,766.40
|
| Rate for Payer: Humana ChoiceCare |
$1,376.96
|
| Rate for Payer: Multiplan All |
$4,819.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,177.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,707.20
|
| Rate for Payer: One Health Plan PPO/POS |
$4,766.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,031.20
|
| Rate for Payer: Three Rivers Provider Network All |
$3,972.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,660.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,324.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,925.28
|
| Rate for Payer: Zelis Auto |
$2,118.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,648.00
|
|
|
IMPLT SHELL ACETABULAR BLACK SOLID 52MM
|
Facility
|
OP
|
$3,639.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006606
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$909.75 |
| Max. Negotiated Rate |
$3,457.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,183.40
|
| Rate for Payer: Cash Price |
$2,183.40
|
| Rate for Payer: Cash Price |
$2,183.40
|
| Rate for Payer: Cigna Commercial |
$3,093.15
|
| Rate for Payer: First Health Commercial |
$3,275.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,275.10
|
| Rate for Payer: GEHA Commercial |
$2,911.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,275.10
|
| Rate for Payer: Humana ChoiceCare |
$946.14
|
| Rate for Payer: Multiplan All |
$3,311.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,183.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,547.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,275.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,457.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,729.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,202.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$909.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,384.27
|
| Rate for Payer: Zelis Auto |
$1,455.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,819.50
|
|
|
IMPLT SHELL ACETABULAR BLACK SOLID 52MM
|
Facility
|
IP
|
$3,639.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006606
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,455.60 |
| Max. Negotiated Rate |
$3,457.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,911.20
|
| Rate for Payer: Cash Price |
$2,183.40
|
| Rate for Payer: Cash Price |
$2,183.40
|
| Rate for Payer: Cigna Commercial |
$3,093.15
|
| Rate for Payer: First Health Commercial |
$3,275.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,275.10
|
| Rate for Payer: GEHA Commercial |
$2,547.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,275.10
|
| Rate for Payer: Multiplan All |
$3,311.49
|
| Rate for Payer: OMNI Networks Commercial |
$2,547.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,275.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,457.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,729.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,384.27
|
| Rate for Payer: Zelis Auto |
$1,455.60
|
|
|
IMPLT SHELL ACETABULAR CLUSTER 42MM
|
Facility
|
IP
|
$4,518.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003489
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,807.20 |
| Max. Negotiated Rate |
$4,292.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,614.40
|
| Rate for Payer: Cash Price |
$2,710.80
|
| Rate for Payer: Cash Price |
$2,710.80
|
| Rate for Payer: Cigna Commercial |
$3,840.30
|
| Rate for Payer: First Health Commercial |
$4,066.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,066.20
|
| Rate for Payer: GEHA Commercial |
$3,162.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,066.20
|
| Rate for Payer: Multiplan All |
$4,111.38
|
| Rate for Payer: OMNI Networks Commercial |
$3,162.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,066.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,292.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,388.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,201.74
|
| Rate for Payer: Zelis Auto |
$1,807.20
|
|
|
IMPLT SHELL ACETABULAR CLUSTER 42MM
|
Facility
|
OP
|
$4,518.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003489
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,129.50 |
| Max. Negotiated Rate |
$4,292.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,710.80
|
| Rate for Payer: Cash Price |
$2,710.80
|
| Rate for Payer: Cash Price |
$2,710.80
|
| Rate for Payer: Cigna Commercial |
$3,840.30
|
| Rate for Payer: First Health Commercial |
$4,066.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,066.20
|
| Rate for Payer: GEHA Commercial |
$3,614.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,066.20
|
| Rate for Payer: Humana ChoiceCare |
$1,174.68
|
| Rate for Payer: Multiplan All |
$4,111.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,710.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,162.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,066.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,292.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,388.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,975.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,129.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,201.74
|
| Rate for Payer: Zelis Auto |
$1,807.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,259.00
|
|
|
IMPLT SHELL ACETABULAR CLUSTER 44MM B
|
Facility
|
IP
|
$4,518.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003500
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,807.20 |
| Max. Negotiated Rate |
$4,292.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,614.40
|
| Rate for Payer: Cash Price |
$2,710.80
|
| Rate for Payer: Cash Price |
$2,710.80
|
| Rate for Payer: Cigna Commercial |
$3,840.30
|
| Rate for Payer: First Health Commercial |
$4,066.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,066.20
|
| Rate for Payer: GEHA Commercial |
$3,162.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,066.20
|
| Rate for Payer: Multiplan All |
$4,111.38
|
| Rate for Payer: OMNI Networks Commercial |
$3,162.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,066.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,292.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,388.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,201.74
|
| Rate for Payer: Zelis Auto |
$1,807.20
|
|
|
IMPLT SHELL ACETABULAR CLUSTER 44MM B
|
Facility
|
OP
|
$4,518.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003500
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,129.50 |
| Max. Negotiated Rate |
$4,292.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,710.80
|
| Rate for Payer: Cash Price |
$2,710.80
|
| Rate for Payer: Cash Price |
$2,710.80
|
| Rate for Payer: Cigna Commercial |
$3,840.30
|
| Rate for Payer: First Health Commercial |
$4,066.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,066.20
|
| Rate for Payer: GEHA Commercial |
$3,614.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,066.20
|
| Rate for Payer: Humana ChoiceCare |
$1,174.68
|
| Rate for Payer: Multiplan All |
$4,111.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,710.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,162.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,066.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,292.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,388.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,975.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,129.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,201.74
|
| Rate for Payer: Zelis Auto |
$1,807.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,259.00
|
|
|
IMPLT SHELL ACETABULAR CLUSTER 46MM
|
Facility
|
IP
|
$4,518.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003444
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,807.20 |
| Max. Negotiated Rate |
$4,292.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,614.40
|
| Rate for Payer: Cash Price |
$2,710.80
|
| Rate for Payer: Cash Price |
$2,710.80
|
| Rate for Payer: Cigna Commercial |
$3,840.30
|
| Rate for Payer: First Health Commercial |
$4,066.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,066.20
|
| Rate for Payer: GEHA Commercial |
$3,162.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,066.20
|
| Rate for Payer: Multiplan All |
$4,111.38
|
| Rate for Payer: OMNI Networks Commercial |
$3,162.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,066.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,292.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,388.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,201.74
|
| Rate for Payer: Zelis Auto |
$1,807.20
|
|
