|
IMPLT SHELL ACETABULAR CLUSTER 46MM
|
Facility
|
OP
|
$4,518.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003444
|
|
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
|
$3,639.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002275
|
|
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 46MM
|
Facility
|
OP
|
$3,639.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002275
|
|
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 CLUSTER 50MM
|
Facility
|
OP
|
$3,409.05
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003494
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$852.26 |
| Max. Negotiated Rate |
$3,238.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,045.43
|
| Rate for Payer: Cash Price |
$2,045.43
|
| Rate for Payer: Cash Price |
$2,045.43
|
| Rate for Payer: Cigna Commercial |
$2,897.69
|
| Rate for Payer: First Health Commercial |
$3,068.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,068.14
|
| Rate for Payer: GEHA Commercial |
$2,727.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,068.14
|
| Rate for Payer: Humana ChoiceCare |
$886.35
|
| Rate for Payer: Multiplan All |
$3,102.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,045.43
|
| Rate for Payer: OMNI Networks Commercial |
$2,386.34
|
| Rate for Payer: One Health Plan PPO/POS |
$3,068.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,238.60
|
| Rate for Payer: Three Rivers Provider Network All |
$2,556.79
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,999.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$852.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,170.42
|
| Rate for Payer: Zelis Auto |
$1,363.62
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,704.53
|
|
|
IMPLT SHELL ACETABULAR CLUSTER 50MM
|
Facility
|
IP
|
$3,409.05
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003494
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,363.62 |
| Max. Negotiated Rate |
$3,238.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,727.24
|
| Rate for Payer: Cash Price |
$2,045.43
|
| Rate for Payer: Cash Price |
$2,045.43
|
| Rate for Payer: Cigna Commercial |
$2,897.69
|
| Rate for Payer: First Health Commercial |
$3,068.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,068.14
|
| Rate for Payer: GEHA Commercial |
$2,386.34
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,068.14
|
| Rate for Payer: Multiplan All |
$3,102.24
|
| Rate for Payer: OMNI Networks Commercial |
$2,386.34
|
| Rate for Payer: One Health Plan PPO/POS |
$3,068.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,238.60
|
| Rate for Payer: Three Rivers Provider Network All |
$2,556.79
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,170.42
|
| Rate for Payer: Zelis Auto |
$1,363.62
|
|
|
IMPLT SHELL ACETABULAR CLUSTER 50MM
|
Facility
|
OP
|
$4,518.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003436
|
|
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 50MM
|
Facility
|
IP
|
$4,518.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003436
|
|
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 50MM
|
Facility
|
IP
|
$3,438.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006388
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,375.20 |
| Max. Negotiated Rate |
$3,266.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,750.40
|
| Rate for Payer: Cash Price |
$2,062.80
|
| Rate for Payer: Cash Price |
$2,062.80
|
| Rate for Payer: Cigna Commercial |
$2,922.30
|
| Rate for Payer: First Health Commercial |
$3,094.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,094.20
|
| Rate for Payer: GEHA Commercial |
$2,406.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,094.20
|
| Rate for Payer: Multiplan All |
$3,128.58
|
| Rate for Payer: OMNI Networks Commercial |
$2,406.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,094.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,266.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,578.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,197.34
|
| Rate for Payer: Zelis Auto |
$1,375.20
|
|
|
IMPLT SHELL ACETABULAR CLUSTER 50MM
|
Facility
|
OP
|
$3,438.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006388
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$859.50 |
| Max. Negotiated Rate |
$3,266.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,062.80
|
| Rate for Payer: Cash Price |
$2,062.80
|
| Rate for Payer: Cash Price |
$2,062.80
|
| Rate for Payer: Cigna Commercial |
$2,922.30
|
| Rate for Payer: First Health Commercial |
$3,094.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,094.20
|
| Rate for Payer: GEHA Commercial |
$2,750.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,094.20
|
| Rate for Payer: Humana ChoiceCare |
$893.88
|
| Rate for Payer: Multiplan All |
$3,128.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,062.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,406.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,094.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,266.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,578.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,025.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$859.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,197.34
|
| Rate for Payer: Zelis Auto |
$1,375.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,719.00
|
|
|
IMPLT SHELL ACETABULAR CLUSTER 52MM
|
Facility
|
IP
|
$4,518.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003382
|
|
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 52MM
|
Facility
|
OP
|
$4,518.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003382
|
|
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 54MM
|
Facility
|
OP
|
$4,518.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003327
|
|
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 54MM
|
Facility
|
IP
|
$4,518.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003327
|
|
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 54MM
|
Facility
|
OP
|
$3,460.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002276
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$865.00 |
| Max. Negotiated Rate |
$3,287.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,076.00
|
| Rate for Payer: Cash Price |
$2,076.00
|
| Rate for Payer: Cash Price |
$2,076.00
|
| Rate for Payer: Cigna Commercial |
$2,941.00
|
| Rate for Payer: First Health Commercial |
$3,114.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,114.00
|
| Rate for Payer: GEHA Commercial |
$2,768.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,114.00
|
| Rate for Payer: Humana ChoiceCare |
$899.60
|
| Rate for Payer: Multiplan All |
$3,148.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,076.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,422.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,114.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,287.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,595.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,044.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$865.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,217.80
|
| Rate for Payer: Zelis Auto |
$1,384.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,730.00
|
|
|
IMPLT SHELL ACETABULAR CLUSTER 54MM
|
Facility
|
IP
|
$3,460.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002276
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,384.00 |
| Max. Negotiated Rate |
$3,287.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,768.00
|
| Rate for Payer: Cash Price |
$2,076.00
|
| Rate for Payer: Cash Price |
$2,076.00
|
| Rate for Payer: Cigna Commercial |
$2,941.00
|
| Rate for Payer: First Health Commercial |
$3,114.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,114.00
|
| Rate for Payer: GEHA Commercial |
$2,422.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,114.00
|
| Rate for Payer: Multiplan All |
$3,148.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,422.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,114.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,287.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,595.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,217.80
|
| Rate for Payer: Zelis Auto |
$1,384.00
|
|
|
IMPLT SHELL ACETABULAR CLUSTER 56MM
|
Facility
|
OP
|
$4,518.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003410
|
|
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 56MM
|
Facility
|
OP
|
$3,460.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$865.00 |
| Max. Negotiated Rate |
$3,287.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,076.00
|
| Rate for Payer: Cash Price |
$2,076.00
|
| Rate for Payer: Cash Price |
$2,076.00
|
| Rate for Payer: Cigna Commercial |
$2,941.00
|
| Rate for Payer: First Health Commercial |
$3,114.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,114.00
|
| Rate for Payer: GEHA Commercial |
$2,768.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,114.00
|
| Rate for Payer: Humana ChoiceCare |
$899.60
|
| Rate for Payer: Multiplan All |
$3,148.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,076.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,422.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,114.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,287.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,595.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,044.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$865.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,217.80
|
| Rate for Payer: Zelis Auto |
$1,384.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,730.00
|
|
|
IMPLT SHELL ACETABULAR CLUSTER 56MM
|
Facility
|
IP
|
$3,460.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,384.00 |
| Max. Negotiated Rate |
$3,287.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,768.00
|
| Rate for Payer: Cash Price |
$2,076.00
|
| Rate for Payer: Cash Price |
$2,076.00
|
| Rate for Payer: Cigna Commercial |
$2,941.00
|
| Rate for Payer: First Health Commercial |
$3,114.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,114.00
|
| Rate for Payer: GEHA Commercial |
$2,422.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,114.00
|
| Rate for Payer: Multiplan All |
$3,148.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,422.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,114.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,287.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,595.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,217.80
|
| Rate for Payer: Zelis Auto |
$1,384.00
|
|
|
IMPLT SHELL ACETABULAR CLUSTER 56MM
|
Facility
|
IP
|
$4,518.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003410
|
|
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 58MM
|
Facility
|
OP
|
$4,518.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003394
|
|
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 58MM
|
Facility
|
IP
|
$4,518.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003394
|
|
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 60MM
|
Facility
|
IP
|
$3,639.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006589
|
|
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 60MM
|
Facility
|
OP
|
$3,639.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006589
|
|
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 CLUSTERHOLE 56
|
Facility
|
OP
|
$4,518.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003429
|
|
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 CLUSTERHOLE 56
|
Facility
|
IP
|
$4,518.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003429
|
|
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
|
|
