|
IMPLT SHELL ACETABULAR CLUSTERHOLE 58
|
Facility
|
IP
|
$4,518.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003454
|
|
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 CLUSTERHOLE 58
|
Facility
|
OP
|
$4,518.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003454
|
|
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 60
|
Facility
|
OP
|
$4,518.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003441
|
|
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 60
|
Facility
|
IP
|
$4,518.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003441
|
|
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 SIZE 52E
|
Facility
|
OP
|
$3,460.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002141
|
|
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 SIZE 52E
|
Facility
|
IP
|
$3,460.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002141
|
|
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 BLACK SOLID HEMISPHERICAL
|
Facility
|
OP
|
$4,872.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002131
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,218.00 |
| Max. Negotiated Rate |
$4,628.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,923.20
|
| Rate for Payer: Cash Price |
$2,923.20
|
| Rate for Payer: Cash Price |
$2,923.20
|
| Rate for Payer: Cigna Commercial |
$4,141.20
|
| Rate for Payer: First Health Commercial |
$4,384.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,384.80
|
| Rate for Payer: GEHA Commercial |
$3,897.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,384.80
|
| Rate for Payer: Humana ChoiceCare |
$1,266.72
|
| Rate for Payer: Multiplan All |
$4,433.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,923.20
|
| Rate for Payer: OMNI Networks Commercial |
$3,410.40
|
| Rate for Payer: One Health Plan PPO/POS |
$4,384.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,628.40
|
| Rate for Payer: Three Rivers Provider Network All |
$3,654.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,287.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,218.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,530.96
|
| Rate for Payer: Zelis Auto |
$1,948.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,436.00
|
|
|
IMPLT SHELL BLACK SOLID HEMISPHERICAL
|
Facility
|
IP
|
$4,872.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002131
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,948.80 |
| Max. Negotiated Rate |
$4,628.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,897.60
|
| Rate for Payer: Cash Price |
$2,923.20
|
| Rate for Payer: Cash Price |
$2,923.20
|
| Rate for Payer: Cigna Commercial |
$4,141.20
|
| Rate for Payer: First Health Commercial |
$4,384.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,384.80
|
| Rate for Payer: GEHA Commercial |
$3,410.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,384.80
|
| Rate for Payer: Multiplan All |
$4,433.52
|
| Rate for Payer: OMNI Networks Commercial |
$3,410.40
|
| Rate for Payer: One Health Plan PPO/POS |
$4,384.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,628.40
|
| Rate for Payer: Three Rivers Provider Network All |
$3,654.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,530.96
|
| Rate for Payer: Zelis Auto |
$1,948.80
|
|
|
IMPLT SHELL CLUSTER ACETABULAR SIZE 48
|
Facility
|
IP
|
$3,460.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002132
|
|
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 CLUSTER ACETABULAR SIZE 48
|
Facility
|
OP
|
$3,460.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002132
|
|
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 CLUSTER ACETABULAR SIZE 58
|
Facility
|
IP
|
$3,460.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002133
|
|
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 CLUSTER ACETABULAR SIZE 58
|
Facility
|
OP
|
$3,460.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002133
|
|
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 CLUSTER ACETABULAR SZ 50
|
Facility
|
OP
|
$3,460.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006550
|
|
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 CLUSTER ACETABULAR SZ 50
|
Facility
|
IP
|
$3,460.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006550
|
|
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 CLUSTER HOLE 52MM
|
Facility
|
OP
|
$4,518.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002142
|
|
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 CLUSTER HOLE 52MM
|
Facility
|
IP
|
$4,518.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002142
|
|
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 CLUSTER HOLE HEMISPHERICAL
|
Facility
|
OP
|
$4,872.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002134
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,218.00 |
| Max. Negotiated Rate |
$4,628.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,923.20
|
| Rate for Payer: Cash Price |
$2,923.20
|
| Rate for Payer: Cash Price |
$2,923.20
|
| Rate for Payer: Cigna Commercial |
$4,141.20
|
| Rate for Payer: First Health Commercial |
$4,384.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,384.80
|
| Rate for Payer: GEHA Commercial |
$3,897.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,384.80
|
| Rate for Payer: Humana ChoiceCare |
$1,266.72
|
| Rate for Payer: Multiplan All |
$4,433.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,923.20
|
| Rate for Payer: OMNI Networks Commercial |
$3,410.40
|
| Rate for Payer: One Health Plan PPO/POS |
$4,384.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,628.40
|
| Rate for Payer: Three Rivers Provider Network All |
$3,654.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,287.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,218.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,530.96
|
| Rate for Payer: Zelis Auto |
$1,948.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,436.00
|
|
|
IMPLT SHELL CLUSTER HOLE HEMISPHERICAL
|
Facility
|
IP
|
$4,872.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002134
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,948.80 |
| Max. Negotiated Rate |
$4,628.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,897.60
|
| Rate for Payer: Cash Price |
$2,923.20
|
| Rate for Payer: Cash Price |
$2,923.20
|
| Rate for Payer: Cigna Commercial |
$4,141.20
|
| Rate for Payer: First Health Commercial |
$4,384.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,384.80
|
| Rate for Payer: GEHA Commercial |
$3,410.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,384.80
|
| Rate for Payer: Multiplan All |
$4,433.52
|
| Rate for Payer: OMNI Networks Commercial |
$3,410.40
|
| Rate for Payer: One Health Plan PPO/POS |
$4,384.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,628.40
|
| Rate for Payer: Three Rivers Provider Network All |
$3,654.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,530.96
|
| Rate for Payer: Zelis Auto |
$1,948.80
|
|
|
IMPLT SHELL CONTINUUM ACETABULAR 52MM
|
Facility
|
OP
|
$8,240.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002278
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,060.00 |
| Max. Negotiated Rate |
$7,828.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,944.00
|
| Rate for Payer: Cash Price |
$4,944.00
|
| Rate for Payer: Cash Price |
$4,944.00
|
| Rate for Payer: Cigna Commercial |
$7,004.00
|
| Rate for Payer: First Health Commercial |
$7,416.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,416.00
|
| Rate for Payer: GEHA Commercial |
$6,592.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,416.00
|
| Rate for Payer: Humana ChoiceCare |
$2,142.40
|
| Rate for Payer: Multiplan All |
$7,498.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,944.00
|
| Rate for Payer: OMNI Networks Commercial |
$5,768.00
|
| Rate for Payer: One Health Plan PPO/POS |
$7,416.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,828.00
|
| Rate for Payer: Three Rivers Provider Network All |
$6,180.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,251.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,060.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,663.20
|
| Rate for Payer: Zelis Auto |
$3,296.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,120.00
|
|
|
IMPLT SHELL CONTINUUM ACETABULAR 52MM
|
Facility
|
IP
|
$8,240.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002278
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,296.00 |
| Max. Negotiated Rate |
$7,828.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,592.00
|
| Rate for Payer: Cash Price |
$4,944.00
|
| Rate for Payer: Cash Price |
$4,944.00
|
| Rate for Payer: Cigna Commercial |
$7,004.00
|
| Rate for Payer: First Health Commercial |
$7,416.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,416.00
|
| Rate for Payer: GEHA Commercial |
$5,768.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,416.00
|
| Rate for Payer: Multiplan All |
$7,498.40
|
| Rate for Payer: OMNI Networks Commercial |
$5,768.00
|
| Rate for Payer: One Health Plan PPO/POS |
$7,416.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,828.00
|
| Rate for Payer: Three Rivers Provider Network All |
$6,180.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,663.20
|
| Rate for Payer: Zelis Auto |
$3,296.00
|
|
|
IMPLT SHELL CONTINUUM ACETABULAR 54MM
|
Facility
|
IP
|
$8,240.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002279
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,296.00 |
| Max. Negotiated Rate |
$7,828.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,592.00
|
| Rate for Payer: Cash Price |
$4,944.00
|
| Rate for Payer: Cash Price |
$4,944.00
|
| Rate for Payer: Cigna Commercial |
$7,004.00
|
| Rate for Payer: First Health Commercial |
$7,416.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,416.00
|
| Rate for Payer: GEHA Commercial |
$5,768.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,416.00
|
| Rate for Payer: Multiplan All |
$7,498.40
|
| Rate for Payer: OMNI Networks Commercial |
$5,768.00
|
| Rate for Payer: One Health Plan PPO/POS |
$7,416.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,828.00
|
| Rate for Payer: Three Rivers Provider Network All |
$6,180.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,663.20
|
| Rate for Payer: Zelis Auto |
$3,296.00
|
|
|
IMPLT SHELL CONTINUUM ACETABULAR 54MM
|
Facility
|
OP
|
$8,240.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002279
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,060.00 |
| Max. Negotiated Rate |
$7,828.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,944.00
|
| Rate for Payer: Cash Price |
$4,944.00
|
| Rate for Payer: Cash Price |
$4,944.00
|
| Rate for Payer: Cigna Commercial |
$7,004.00
|
| Rate for Payer: First Health Commercial |
$7,416.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,416.00
|
| Rate for Payer: GEHA Commercial |
$6,592.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,416.00
|
| Rate for Payer: Humana ChoiceCare |
$2,142.40
|
| Rate for Payer: Multiplan All |
$7,498.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,944.00
|
| Rate for Payer: OMNI Networks Commercial |
$5,768.00
|
| Rate for Payer: One Health Plan PPO/POS |
$7,416.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,828.00
|
| Rate for Payer: Three Rivers Provider Network All |
$6,180.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,251.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,060.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,663.20
|
| Rate for Payer: Zelis Auto |
$3,296.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,120.00
|
|
|
IMPLT SHELL HEMI CLUSTER HOLE 48MM C
|
Facility
|
OP
|
$4,518.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002135
|
|
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 HEMI CLUSTER HOLE 48MM C
|
Facility
|
IP
|
$4,518.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002135
|
|
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 HEMISPHERICAL SIZE 54MM
|
Facility
|
IP
|
$9,310.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003314
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,724.00 |
| Max. Negotiated Rate |
$8,844.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7,448.00
|
| Rate for Payer: Cash Price |
$5,586.00
|
| Rate for Payer: Cash Price |
$5,586.00
|
| Rate for Payer: Cigna Commercial |
$7,913.50
|
| Rate for Payer: First Health Commercial |
$8,379.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,379.00
|
| Rate for Payer: GEHA Commercial |
$6,517.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,379.00
|
| Rate for Payer: Multiplan All |
$8,472.10
|
| Rate for Payer: OMNI Networks Commercial |
$6,517.00
|
| Rate for Payer: One Health Plan PPO/POS |
$8,379.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,844.50
|
| Rate for Payer: Three Rivers Provider Network All |
$6,982.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,658.30
|
| Rate for Payer: Zelis Auto |
$3,724.00
|
|
