|
IMPLT STD PAT A SERIES 37 3 PEG
|
Facility
|
IP
|
$2,081.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003308
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$832.40 |
| Max. Negotiated Rate |
$1,976.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,664.80
|
| Rate for Payer: Cash Price |
$1,248.60
|
| Rate for Payer: Cash Price |
$1,248.60
|
| Rate for Payer: Cigna Commercial |
$1,768.85
|
| Rate for Payer: First Health Commercial |
$1,872.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,872.90
|
| Rate for Payer: GEHA Commercial |
$1,456.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,872.90
|
| Rate for Payer: Multiplan All |
$1,893.71
|
| Rate for Payer: OMNI Networks Commercial |
$1,456.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,872.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,976.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,560.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,935.33
|
| Rate for Payer: Zelis Auto |
$832.40
|
|
|
IMPLT STEM ASSEMBLY
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002290
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$37.75 |
| Max. Negotiated Rate |
$143.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$90.60
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$128.35
|
| Rate for Payer: First Health Commercial |
$135.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$135.90
|
| Rate for Payer: GEHA Commercial |
$120.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$135.90
|
| Rate for Payer: Humana ChoiceCare |
$39.26
|
| Rate for Payer: Multiplan All |
$137.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$90.60
|
| Rate for Payer: OMNI Networks Commercial |
$105.70
|
| Rate for Payer: One Health Plan PPO/POS |
$135.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$143.45
|
| Rate for Payer: Three Rivers Provider Network All |
$113.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$132.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$37.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$140.43
|
| Rate for Payer: Zelis Auto |
$60.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$75.50
|
|
|
IMPLT STEM ASSEMBLY
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002290
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.40 |
| Max. Negotiated Rate |
$143.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$120.80
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$128.35
|
| Rate for Payer: First Health Commercial |
$135.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$135.90
|
| Rate for Payer: GEHA Commercial |
$105.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$135.90
|
| Rate for Payer: Multiplan All |
$137.41
|
| Rate for Payer: OMNI Networks Commercial |
$105.70
|
| Rate for Payer: One Health Plan PPO/POS |
$135.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$143.45
|
| Rate for Payer: Three Rivers Provider Network All |
$113.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$140.43
|
| Rate for Payer: Zelis Auto |
$60.40
|
|
|
IMPLT STEM CEMENTED KNEE TOTAL 12MM
|
Facility
|
IP
|
$3,920.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,568.00 |
| Max. Negotiated Rate |
$3,724.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,136.00
|
| Rate for Payer: Cash Price |
$2,352.00
|
| Rate for Payer: Cash Price |
$2,352.00
|
| Rate for Payer: Cigna Commercial |
$3,332.00
|
| Rate for Payer: First Health Commercial |
$3,528.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,528.00
|
| Rate for Payer: GEHA Commercial |
$2,744.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,528.00
|
| Rate for Payer: Multiplan All |
$3,567.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,744.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,528.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,724.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,940.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,645.60
|
| Rate for Payer: Zelis Auto |
$1,568.00
|
|
|
IMPLT STEM CEMENTED KNEE TOTAL 12MM
|
Facility
|
OP
|
$3,920.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$980.00 |
| Max. Negotiated Rate |
$3,724.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,352.00
|
| Rate for Payer: Cash Price |
$2,352.00
|
| Rate for Payer: Cash Price |
$2,352.00
|
| Rate for Payer: Cigna Commercial |
$3,332.00
|
| Rate for Payer: First Health Commercial |
$3,528.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,528.00
|
| Rate for Payer: GEHA Commercial |
$3,136.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,528.00
|
| Rate for Payer: Humana ChoiceCare |
$1,019.20
|
| Rate for Payer: Multiplan All |
$3,567.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,352.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,744.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,528.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,724.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,940.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,449.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$980.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,645.60
|
| Rate for Payer: Zelis Auto |
$1,568.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,960.00
|
|
|
IMPLT STEM CEMENTED KNEE TOTAL 9MM 50MM
|
Facility
|
OP
|
$4,040.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003152
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,010.00 |
| Max. Negotiated Rate |
$3,838.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,424.00
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cigna Commercial |
$3,434.00
|
| Rate for Payer: First Health Commercial |
$3,636.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,636.00
|
| Rate for Payer: GEHA Commercial |
$3,232.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,636.00
|
| Rate for Payer: Humana ChoiceCare |
$1,050.40
|
| Rate for Payer: Multiplan All |
$3,676.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,424.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,828.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,636.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,838.00
|
| Rate for Payer: Three Rivers Provider Network All |
$3,030.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,555.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,010.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,757.20
|
| Rate for Payer: Zelis Auto |
$1,616.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,020.00
|
|
|
IMPLT STEM CEMENTED KNEE TOTAL 9MM 50MM
|
Facility
|
IP
|
$4,040.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003152
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,616.00 |
| Max. Negotiated Rate |
$3,838.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,232.00
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cigna Commercial |
$3,434.00
|
| Rate for Payer: First Health Commercial |
$3,636.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,636.00
|
| Rate for Payer: GEHA Commercial |
$2,828.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,636.00
|
| Rate for Payer: Multiplan All |
$3,676.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,828.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,636.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,838.00
|
| Rate for Payer: Three Rivers Provider Network All |
$3,030.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,757.20
|
| Rate for Payer: Zelis Auto |
$1,616.00
|
|
|
IMPLT STEM CEMENTED KNEE TOTAL 9X100MM
|
Facility
|
IP
|
$4,728.93
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006409
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,891.57 |
| Max. Negotiated Rate |
$4,492.48 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,783.14
|
| Rate for Payer: Cash Price |
$2,837.36
|
| Rate for Payer: Cash Price |
$2,837.36
|
| Rate for Payer: Cigna Commercial |
$4,019.59
|
| Rate for Payer: First Health Commercial |
$4,256.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,256.04
|
| Rate for Payer: GEHA Commercial |
$3,310.25
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,256.04
|
| Rate for Payer: Multiplan All |
$4,303.33
|
| Rate for Payer: OMNI Networks Commercial |
$3,310.25
|
| Rate for Payer: One Health Plan PPO/POS |
$4,256.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,492.48
|
| Rate for Payer: Three Rivers Provider Network All |
$3,546.70
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,397.90
|
| Rate for Payer: Zelis Auto |
$1,891.57
|
|
|
IMPLT STEM CEMENTED KNEE TOTAL 9X100MM
|
Facility
|
OP
|
$4,728.93
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006409
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,182.23 |
| Max. Negotiated Rate |
$4,492.48 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,837.36
|
| Rate for Payer: Cash Price |
$2,837.36
|
| Rate for Payer: Cash Price |
$2,837.36
|
| Rate for Payer: Cigna Commercial |
$4,019.59
|
| Rate for Payer: First Health Commercial |
$4,256.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,256.04
|
| Rate for Payer: GEHA Commercial |
$3,783.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,256.04
|
| Rate for Payer: Humana ChoiceCare |
$1,229.52
|
| Rate for Payer: Multiplan All |
$4,303.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,837.36
|
| Rate for Payer: OMNI Networks Commercial |
$3,310.25
|
| Rate for Payer: One Health Plan PPO/POS |
$4,256.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,492.48
|
| Rate for Payer: Three Rivers Provider Network All |
$3,546.70
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,161.46
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,182.23
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,397.90
|
| Rate for Payer: Zelis Auto |
$1,891.57
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,364.47
|
|
|
IMPLT STEM CEMENTED TOTAL KNEE 15MM DIAM
|
Facility
|
OP
|
$4,132.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002291
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,033.00 |
| Max. Negotiated Rate |
$3,925.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,479.20
|
| Rate for Payer: Cash Price |
$2,479.20
|
| Rate for Payer: Cash Price |
$2,479.20
|
| Rate for Payer: Cigna Commercial |
$3,512.20
|
| Rate for Payer: First Health Commercial |
$3,718.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,718.80
|
| Rate for Payer: GEHA Commercial |
$3,305.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,718.80
|
| Rate for Payer: Humana ChoiceCare |
$1,074.32
|
| Rate for Payer: Multiplan All |
$3,760.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,479.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,892.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,718.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,925.40
|
| Rate for Payer: Three Rivers Provider Network All |
$3,099.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,636.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,033.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,842.76
|
| Rate for Payer: Zelis Auto |
$1,652.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,066.00
|
|
|
IMPLT STEM CEMENTED TOTAL KNEE 15MM DIAM
|
Facility
|
IP
|
$4,132.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002291
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,652.80 |
| Max. Negotiated Rate |
$3,925.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,305.60
|
| Rate for Payer: Cash Price |
$2,479.20
|
| Rate for Payer: Cash Price |
$2,479.20
|
| Rate for Payer: Cigna Commercial |
$3,512.20
|
| Rate for Payer: First Health Commercial |
$3,718.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,718.80
|
| Rate for Payer: GEHA Commercial |
$2,892.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,718.80
|
| Rate for Payer: Multiplan All |
$3,760.12
|
| Rate for Payer: OMNI Networks Commercial |
$2,892.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,718.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,925.40
|
| Rate for Payer: Three Rivers Provider Network All |
$3,099.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,842.76
|
| Rate for Payer: Zelis Auto |
$1,652.80
|
|
|
IMPLT STEM CEMENTED TRIATHLON 12X100MM
|
Facility
|
OP
|
$4,132.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002162
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,033.00 |
| Max. Negotiated Rate |
$3,925.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,479.20
|
| Rate for Payer: Cash Price |
$2,479.20
|
| Rate for Payer: Cash Price |
$2,479.20
|
| Rate for Payer: Cigna Commercial |
$3,512.20
|
| Rate for Payer: First Health Commercial |
$3,718.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,718.80
|
| Rate for Payer: GEHA Commercial |
$3,305.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,718.80
|
| Rate for Payer: Humana ChoiceCare |
$1,074.32
|
| Rate for Payer: Multiplan All |
$3,760.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,479.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,892.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,718.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,925.40
|
| Rate for Payer: Three Rivers Provider Network All |
$3,099.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,636.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,033.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,842.76
|
| Rate for Payer: Zelis Auto |
$1,652.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,066.00
|
|
|
IMPLT STEM CEMENTED TRIATHLON 12X100MM
|
Facility
|
IP
|
$4,132.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002162
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,652.80 |
| Max. Negotiated Rate |
$3,925.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,305.60
|
| Rate for Payer: Cash Price |
$2,479.20
|
| Rate for Payer: Cash Price |
$2,479.20
|
| Rate for Payer: Cigna Commercial |
$3,512.20
|
| Rate for Payer: First Health Commercial |
$3,718.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,718.80
|
| Rate for Payer: GEHA Commercial |
$2,892.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,718.80
|
| Rate for Payer: Multiplan All |
$3,760.12
|
| Rate for Payer: OMNI Networks Commercial |
$2,892.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,718.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,925.40
|
| Rate for Payer: Three Rivers Provider Network All |
$3,099.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,842.76
|
| Rate for Payer: Zelis Auto |
$1,652.80
|
|
|
IMPLT STEM CEMENTED TRIATHLON 15X50MM
|
Facility
|
OP
|
$3,798.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002146
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$949.50 |
| Max. Negotiated Rate |
$3,608.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,278.80
|
| Rate for Payer: Cash Price |
$2,278.80
|
| Rate for Payer: Cash Price |
$2,278.80
|
| Rate for Payer: Cigna Commercial |
$3,228.30
|
| Rate for Payer: First Health Commercial |
$3,418.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,418.20
|
| Rate for Payer: GEHA Commercial |
$3,038.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,418.20
|
| Rate for Payer: Humana ChoiceCare |
$987.48
|
| Rate for Payer: Multiplan All |
$3,456.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,278.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,658.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,418.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,608.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,848.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,342.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$949.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,532.14
|
| Rate for Payer: Zelis Auto |
$1,519.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,899.00
|
|
|
IMPLT STEM CEMENTED TRIATHLON 15X50MM
|
Facility
|
IP
|
$3,798.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002146
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,519.20 |
| Max. Negotiated Rate |
$3,608.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,038.40
|
| Rate for Payer: Cash Price |
$2,278.80
|
| Rate for Payer: Cash Price |
$2,278.80
|
| Rate for Payer: Cigna Commercial |
$3,228.30
|
| Rate for Payer: First Health Commercial |
$3,418.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,418.20
|
| Rate for Payer: GEHA Commercial |
$2,658.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,418.20
|
| Rate for Payer: Multiplan All |
$3,456.18
|
| Rate for Payer: OMNI Networks Commercial |
$2,658.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,418.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,608.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,848.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,532.14
|
| Rate for Payer: Zelis Auto |
$1,519.20
|
|
|
IMPLT STEM CENTRALIZED 13X145MM
|
Facility
|
IP
|
$5,371.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002292
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,148.40 |
| Max. Negotiated Rate |
$5,102.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,296.80
|
| Rate for Payer: Cash Price |
$3,222.60
|
| Rate for Payer: Cash Price |
$3,222.60
|
| Rate for Payer: Cigna Commercial |
$4,565.35
|
| Rate for Payer: First Health Commercial |
$4,833.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,833.90
|
| Rate for Payer: GEHA Commercial |
$3,759.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,833.90
|
| Rate for Payer: Multiplan All |
$4,887.61
|
| Rate for Payer: OMNI Networks Commercial |
$3,759.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,833.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,102.45
|
| Rate for Payer: Three Rivers Provider Network All |
$4,028.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,995.03
|
| Rate for Payer: Zelis Auto |
$2,148.40
|
|
|
IMPLT STEM CENTRALIZED 13X145MM
|
Facility
|
OP
|
$5,371.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002292
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,342.75 |
| Max. Negotiated Rate |
$5,102.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,222.60
|
| Rate for Payer: Cash Price |
$3,222.60
|
| Rate for Payer: Cash Price |
$3,222.60
|
| Rate for Payer: Cigna Commercial |
$4,565.35
|
| Rate for Payer: First Health Commercial |
$4,833.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,833.90
|
| Rate for Payer: GEHA Commercial |
$4,296.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,833.90
|
| Rate for Payer: Humana ChoiceCare |
$1,396.46
|
| Rate for Payer: Multiplan All |
$4,887.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,222.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,759.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,833.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,102.45
|
| Rate for Payer: Three Rivers Provider Network All |
$4,028.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,726.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,342.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,995.03
|
| Rate for Payer: Zelis Auto |
$2,148.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,685.50
|
|
|
IMPLT STEM CENTRALIZER 13X145MM
|
Facility
|
IP
|
$5,371.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002293
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,148.40 |
| Max. Negotiated Rate |
$5,102.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,296.80
|
| Rate for Payer: Cash Price |
$3,222.60
|
| Rate for Payer: Cash Price |
$3,222.60
|
| Rate for Payer: Cigna Commercial |
$4,565.35
|
| Rate for Payer: First Health Commercial |
$4,833.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,833.90
|
| Rate for Payer: GEHA Commercial |
$3,759.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,833.90
|
| Rate for Payer: Multiplan All |
$4,887.61
|
| Rate for Payer: OMNI Networks Commercial |
$3,759.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,833.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,102.45
|
| Rate for Payer: Three Rivers Provider Network All |
$4,028.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,995.03
|
| Rate for Payer: Zelis Auto |
$2,148.40
|
|
|
IMPLT STEM CENTRALIZER 13X145MM
|
Facility
|
OP
|
$5,371.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002293
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,342.75 |
| Max. Negotiated Rate |
$5,102.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,222.60
|
| Rate for Payer: Cash Price |
$3,222.60
|
| Rate for Payer: Cash Price |
$3,222.60
|
| Rate for Payer: Cigna Commercial |
$4,565.35
|
| Rate for Payer: First Health Commercial |
$4,833.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,833.90
|
| Rate for Payer: GEHA Commercial |
$4,296.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,833.90
|
| Rate for Payer: Humana ChoiceCare |
$1,396.46
|
| Rate for Payer: Multiplan All |
$4,887.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,222.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,759.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,833.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,102.45
|
| Rate for Payer: Three Rivers Provider Network All |
$4,028.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,726.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,342.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,995.03
|
| Rate for Payer: Zelis Auto |
$2,148.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,685.50
|
|
|
IMPLT STEM COMPREHENSIVE 9X83MM
|
Facility
|
IP
|
$16,531.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002163
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,612.40 |
| Max. Negotiated Rate |
$15,704.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$13,224.80
|
| Rate for Payer: Cash Price |
$9,918.60
|
| Rate for Payer: Cash Price |
$9,918.60
|
| Rate for Payer: Cigna Commercial |
$14,051.35
|
| Rate for Payer: First Health Commercial |
$14,877.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$14,877.90
|
| Rate for Payer: GEHA Commercial |
$11,571.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$14,877.90
|
| Rate for Payer: Multiplan All |
$15,043.21
|
| Rate for Payer: OMNI Networks Commercial |
$11,571.70
|
| Rate for Payer: One Health Plan PPO/POS |
$14,877.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$15,704.45
|
| Rate for Payer: Three Rivers Provider Network All |
$12,398.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$15,373.83
|
| Rate for Payer: Zelis Auto |
$6,612.40
|
|
|
IMPLT STEM COMPREHENSIVE 9X83MM
|
Facility
|
OP
|
$16,531.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002163
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,132.75 |
| Max. Negotiated Rate |
$15,704.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9,918.60
|
| Rate for Payer: Cash Price |
$9,918.60
|
| Rate for Payer: Cash Price |
$9,918.60
|
| Rate for Payer: Cigna Commercial |
$14,051.35
|
| Rate for Payer: First Health Commercial |
$14,877.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$14,877.90
|
| Rate for Payer: GEHA Commercial |
$13,224.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$14,877.90
|
| Rate for Payer: Humana ChoiceCare |
$4,298.06
|
| Rate for Payer: Multiplan All |
$15,043.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,918.60
|
| Rate for Payer: OMNI Networks Commercial |
$11,571.70
|
| Rate for Payer: One Health Plan PPO/POS |
$14,877.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$15,704.45
|
| Rate for Payer: Three Rivers Provider Network All |
$12,398.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14,547.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,132.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$15,373.83
|
| Rate for Payer: Zelis Auto |
$6,612.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,265.50
|
|
|
IMPLT STEM COMPREHENSIVE MINI 12X83
|
Facility
|
OP
|
$16,531.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002294
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,132.75 |
| Max. Negotiated Rate |
$15,704.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9,918.60
|
| Rate for Payer: Cash Price |
$9,918.60
|
| Rate for Payer: Cash Price |
$9,918.60
|
| Rate for Payer: Cigna Commercial |
$14,051.35
|
| Rate for Payer: First Health Commercial |
$14,877.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$14,877.90
|
| Rate for Payer: GEHA Commercial |
$13,224.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$14,877.90
|
| Rate for Payer: Humana ChoiceCare |
$4,298.06
|
| Rate for Payer: Multiplan All |
$15,043.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,918.60
|
| Rate for Payer: OMNI Networks Commercial |
$11,571.70
|
| Rate for Payer: One Health Plan PPO/POS |
$14,877.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$15,704.45
|
| Rate for Payer: Three Rivers Provider Network All |
$12,398.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14,547.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,132.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$15,373.83
|
| Rate for Payer: Zelis Auto |
$6,612.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,265.50
|
|
|
IMPLT STEM COMPREHENSIVE MINI 12X83
|
Facility
|
IP
|
$16,531.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002294
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,612.40 |
| Max. Negotiated Rate |
$15,704.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$13,224.80
|
| Rate for Payer: Cash Price |
$9,918.60
|
| Rate for Payer: Cash Price |
$9,918.60
|
| Rate for Payer: Cigna Commercial |
$14,051.35
|
| Rate for Payer: First Health Commercial |
$14,877.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$14,877.90
|
| Rate for Payer: GEHA Commercial |
$11,571.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$14,877.90
|
| Rate for Payer: Multiplan All |
$15,043.21
|
| Rate for Payer: OMNI Networks Commercial |
$11,571.70
|
| Rate for Payer: One Health Plan PPO/POS |
$14,877.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$15,704.45
|
| Rate for Payer: Three Rivers Provider Network All |
$12,398.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$15,373.83
|
| Rate for Payer: Zelis Auto |
$6,612.40
|
|
|
IMPLT STEM EXPLOR 7X26MM
|
Facility
|
OP
|
$6,827.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002295
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,706.75 |
| Max. Negotiated Rate |
$6,485.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,096.20
|
| Rate for Payer: Cash Price |
$4,096.20
|
| Rate for Payer: Cash Price |
$4,096.20
|
| Rate for Payer: Cigna Commercial |
$5,802.95
|
| Rate for Payer: First Health Commercial |
$6,144.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,144.30
|
| Rate for Payer: GEHA Commercial |
$5,461.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,144.30
|
| Rate for Payer: Humana ChoiceCare |
$1,775.02
|
| Rate for Payer: Multiplan All |
$6,212.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,096.20
|
| Rate for Payer: OMNI Networks Commercial |
$4,778.90
|
| Rate for Payer: One Health Plan PPO/POS |
$6,144.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,485.65
|
| Rate for Payer: Three Rivers Provider Network All |
$5,120.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,007.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,706.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,349.11
|
| Rate for Payer: Zelis Auto |
$2,730.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,413.50
|
|
|
IMPLT STEM EXPLOR 7X26MM
|
Facility
|
IP
|
$6,827.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002295
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,730.80 |
| Max. Negotiated Rate |
$6,485.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,461.60
|
| Rate for Payer: Cash Price |
$4,096.20
|
| Rate for Payer: Cash Price |
$4,096.20
|
| Rate for Payer: Cigna Commercial |
$5,802.95
|
| Rate for Payer: First Health Commercial |
$6,144.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,144.30
|
| Rate for Payer: GEHA Commercial |
$4,778.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,144.30
|
| Rate for Payer: Multiplan All |
$6,212.57
|
| Rate for Payer: OMNI Networks Commercial |
$4,778.90
|
| Rate for Payer: One Health Plan PPO/POS |
$6,144.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,485.65
|
| Rate for Payer: Three Rivers Provider Network All |
$5,120.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,349.11
|
| Rate for Payer: Zelis Auto |
$2,730.80
|
|
