|
IMPLT STEM FEMORAL CENTRALIZER11X135
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002297
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$121.60 |
| Max. Negotiated Rate |
$288.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$243.20
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cigna Commercial |
$258.40
|
| Rate for Payer: First Health Commercial |
$273.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$273.60
|
| Rate for Payer: GEHA Commercial |
$212.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$273.60
|
| Rate for Payer: Multiplan All |
$276.64
|
| Rate for Payer: OMNI Networks Commercial |
$212.80
|
| Rate for Payer: One Health Plan PPO/POS |
$273.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$288.80
|
| Rate for Payer: Three Rivers Provider Network All |
$228.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$282.72
|
| Rate for Payer: Zelis Auto |
$121.60
|
|
|
IMPLT STEM FEMORAL CENTRALIZER11X135
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002297
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$76.00 |
| Max. Negotiated Rate |
$288.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$182.40
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cigna Commercial |
$258.40
|
| Rate for Payer: First Health Commercial |
$273.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$273.60
|
| Rate for Payer: GEHA Commercial |
$243.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$273.60
|
| Rate for Payer: Humana ChoiceCare |
$79.04
|
| Rate for Payer: Multiplan All |
$276.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$182.40
|
| Rate for Payer: OMNI Networks Commercial |
$212.80
|
| Rate for Payer: One Health Plan PPO/POS |
$273.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$288.80
|
| Rate for Payer: Three Rivers Provider Network All |
$228.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$267.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$76.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$282.72
|
| Rate for Payer: Zelis Auto |
$121.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$152.00
|
|
|
IMPLT STEM FEMORAL CENTRALIZER 9X125
|
Facility
|
OP
|
$5,371.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002296
|
|
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 FEMORAL CENTRALIZER 9X125
|
Facility
|
IP
|
$5,371.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002296
|
|
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 FEMORAL NECK STANDARD 30
|
Facility
|
OP
|
$11,394.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002574
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,848.50 |
| Max. Negotiated Rate |
$10,824.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,836.40
|
| Rate for Payer: Cash Price |
$6,836.40
|
| Rate for Payer: Cash Price |
$6,836.40
|
| Rate for Payer: Cigna Commercial |
$9,684.90
|
| Rate for Payer: First Health Commercial |
$10,254.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10,254.60
|
| Rate for Payer: GEHA Commercial |
$9,115.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10,254.60
|
| Rate for Payer: Humana ChoiceCare |
$2,962.44
|
| Rate for Payer: Multiplan All |
$10,368.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6,836.40
|
| Rate for Payer: OMNI Networks Commercial |
$7,975.80
|
| Rate for Payer: One Health Plan PPO/POS |
$10,254.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10,824.30
|
| Rate for Payer: Three Rivers Provider Network All |
$8,545.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10,026.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,848.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$10,596.42
|
| Rate for Payer: Zelis Auto |
$4,557.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,697.00
|
|
|
IMPLT STEM FEMORAL NECK STANDARD 30
|
Facility
|
IP
|
$11,394.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002574
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,557.60 |
| Max. Negotiated Rate |
$10,824.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9,115.20
|
| Rate for Payer: Cash Price |
$6,836.40
|
| Rate for Payer: Cash Price |
$6,836.40
|
| Rate for Payer: Cigna Commercial |
$9,684.90
|
| Rate for Payer: First Health Commercial |
$10,254.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10,254.60
|
| Rate for Payer: GEHA Commercial |
$7,975.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10,254.60
|
| Rate for Payer: Multiplan All |
$10,368.54
|
| Rate for Payer: OMNI Networks Commercial |
$7,975.80
|
| Rate for Payer: One Health Plan PPO/POS |
$10,254.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10,824.30
|
| Rate for Payer: Three Rivers Provider Network All |
$8,545.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$10,596.42
|
| Rate for Payer: Zelis Auto |
$4,557.60
|
|
|
IMPLT STEM FLUTED 12X100MM TS
|
Facility
|
IP
|
$4,719.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002298
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,887.60 |
| Max. Negotiated Rate |
$4,483.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,775.20
|
| Rate for Payer: Cash Price |
$2,831.40
|
| Rate for Payer: Cash Price |
$2,831.40
|
| Rate for Payer: Cigna Commercial |
$4,011.15
|
| Rate for Payer: First Health Commercial |
$4,247.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,247.10
|
| Rate for Payer: GEHA Commercial |
$3,303.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,247.10
|
| Rate for Payer: Multiplan All |
$4,294.29
|
| Rate for Payer: OMNI Networks Commercial |
$3,303.30
|
| Rate for Payer: One Health Plan PPO/POS |
$4,247.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,483.05
|
| Rate for Payer: Three Rivers Provider Network All |
$3,539.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,388.67
|
| Rate for Payer: Zelis Auto |
$1,887.60
|
|
|
IMPLT STEM FLUTED 12X100MM TS
|
Facility
|
OP
|
$4,719.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002298
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,179.75 |
| Max. Negotiated Rate |
$4,483.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,831.40
|
| Rate for Payer: Cash Price |
$2,831.40
|
| Rate for Payer: Cash Price |
$2,831.40
|
| Rate for Payer: Cigna Commercial |
$4,011.15
|
| Rate for Payer: First Health Commercial |
$4,247.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,247.10
|
| Rate for Payer: GEHA Commercial |
$3,775.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,247.10
|
| Rate for Payer: Humana ChoiceCare |
$1,226.94
|
| Rate for Payer: Multiplan All |
$4,294.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,831.40
|
| Rate for Payer: OMNI Networks Commercial |
$3,303.30
|
| Rate for Payer: One Health Plan PPO/POS |
$4,247.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,483.05
|
| Rate for Payer: Three Rivers Provider Network All |
$3,539.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,152.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,179.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,388.67
|
| Rate for Payer: Zelis Auto |
$1,887.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,359.50
|
|
|
IMPLT STEM FLUTED 15X100MM
|
Facility
|
OP
|
$3,943.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002267
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$985.75 |
| Max. Negotiated Rate |
$3,745.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,365.80
|
| Rate for Payer: Cash Price |
$2,365.80
|
| Rate for Payer: Cash Price |
$2,365.80
|
| Rate for Payer: Cigna Commercial |
$3,351.55
|
| Rate for Payer: First Health Commercial |
$3,548.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,548.70
|
| Rate for Payer: GEHA Commercial |
$3,154.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,548.70
|
| Rate for Payer: Humana ChoiceCare |
$1,025.18
|
| Rate for Payer: Multiplan All |
$3,588.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,365.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,760.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,548.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,745.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2,957.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,469.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$985.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,666.99
|
| Rate for Payer: Zelis Auto |
$1,577.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,971.50
|
|
|
IMPLT STEM FLUTED 15X100MM
|
Facility
|
IP
|
$3,943.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002267
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,577.20 |
| Max. Negotiated Rate |
$3,745.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,154.40
|
| Rate for Payer: Cash Price |
$2,365.80
|
| Rate for Payer: Cash Price |
$2,365.80
|
| Rate for Payer: Cigna Commercial |
$3,351.55
|
| Rate for Payer: First Health Commercial |
$3,548.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,548.70
|
| Rate for Payer: GEHA Commercial |
$2,760.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,548.70
|
| Rate for Payer: Multiplan All |
$3,588.13
|
| Rate for Payer: OMNI Networks Commercial |
$2,760.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,548.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,745.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2,957.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,666.99
|
| Rate for Payer: Zelis Auto |
$1,577.20
|
|
|
IMPLT STEM FLUTED TITANIUM 10X155MM
|
Facility
|
OP
|
$3,453.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002679
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$863.25 |
| Max. Negotiated Rate |
$3,280.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,071.80
|
| Rate for Payer: Cash Price |
$2,071.80
|
| Rate for Payer: Cash Price |
$2,071.80
|
| Rate for Payer: Cigna Commercial |
$2,935.05
|
| Rate for Payer: First Health Commercial |
$3,107.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,107.70
|
| Rate for Payer: GEHA Commercial |
$2,762.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,107.70
|
| Rate for Payer: Humana ChoiceCare |
$897.78
|
| Rate for Payer: Multiplan All |
$3,142.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,071.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,417.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,107.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,280.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,589.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,038.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$863.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,211.29
|
| Rate for Payer: Zelis Auto |
$1,381.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,726.50
|
|
|
IMPLT STEM FLUTED TITANIUM 10X155MM
|
Facility
|
IP
|
$3,453.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002679
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,381.20 |
| Max. Negotiated Rate |
$3,280.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,762.40
|
| Rate for Payer: Cash Price |
$2,071.80
|
| Rate for Payer: Cash Price |
$2,071.80
|
| Rate for Payer: Cigna Commercial |
$2,935.05
|
| Rate for Payer: First Health Commercial |
$3,107.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,107.70
|
| Rate for Payer: GEHA Commercial |
$2,417.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,107.70
|
| Rate for Payer: Multiplan All |
$3,142.23
|
| Rate for Payer: OMNI Networks Commercial |
$2,417.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,107.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,280.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,589.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,211.29
|
| Rate for Payer: Zelis Auto |
$1,381.20
|
|
|
IMPLT STEM FLUTED TRIATHLON 14X100MM
|
Facility
|
IP
|
$3,943.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002942
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,577.20 |
| Max. Negotiated Rate |
$3,745.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,154.40
|
| Rate for Payer: Cash Price |
$2,365.80
|
| Rate for Payer: Cash Price |
$2,365.80
|
| Rate for Payer: Cigna Commercial |
$3,351.55
|
| Rate for Payer: First Health Commercial |
$3,548.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,548.70
|
| Rate for Payer: GEHA Commercial |
$2,760.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,548.70
|
| Rate for Payer: Multiplan All |
$3,588.13
|
| Rate for Payer: OMNI Networks Commercial |
$2,760.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,548.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,745.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2,957.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,666.99
|
| Rate for Payer: Zelis Auto |
$1,577.20
|
|
|
IMPLT STEM FLUTED TRIATHLON 14X100MM
|
Facility
|
OP
|
$3,943.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002942
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$985.75 |
| Max. Negotiated Rate |
$3,745.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,365.80
|
| Rate for Payer: Cash Price |
$2,365.80
|
| Rate for Payer: Cash Price |
$2,365.80
|
| Rate for Payer: Cigna Commercial |
$3,351.55
|
| Rate for Payer: First Health Commercial |
$3,548.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,548.70
|
| Rate for Payer: GEHA Commercial |
$3,154.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,548.70
|
| Rate for Payer: Humana ChoiceCare |
$1,025.18
|
| Rate for Payer: Multiplan All |
$3,588.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,365.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,760.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,548.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,745.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2,957.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,469.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$985.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,666.99
|
| Rate for Payer: Zelis Auto |
$1,577.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,971.50
|
|
|
IMPLT STEM FLUTED TRIATHLON 20X100MM
|
Facility
|
IP
|
$3,949.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002671
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,579.60 |
| Max. Negotiated Rate |
$3,751.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,159.20
|
| Rate for Payer: Cash Price |
$2,369.40
|
| Rate for Payer: Cash Price |
$2,369.40
|
| Rate for Payer: Cigna Commercial |
$3,356.65
|
| Rate for Payer: First Health Commercial |
$3,554.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,554.10
|
| Rate for Payer: GEHA Commercial |
$2,764.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,554.10
|
| Rate for Payer: Multiplan All |
$3,593.59
|
| Rate for Payer: OMNI Networks Commercial |
$2,764.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,554.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,751.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,961.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,672.57
|
| Rate for Payer: Zelis Auto |
$1,579.60
|
|
|
IMPLT STEM FLUTED TRIATHLON 20X100MM
|
Facility
|
OP
|
$3,949.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002671
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$987.25 |
| Max. Negotiated Rate |
$3,751.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,369.40
|
| Rate for Payer: Cash Price |
$2,369.40
|
| Rate for Payer: Cash Price |
$2,369.40
|
| Rate for Payer: Cigna Commercial |
$3,356.65
|
| Rate for Payer: First Health Commercial |
$3,554.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,554.10
|
| Rate for Payer: GEHA Commercial |
$3,159.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,554.10
|
| Rate for Payer: Humana ChoiceCare |
$1,026.74
|
| Rate for Payer: Multiplan All |
$3,593.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,369.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,764.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,554.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,751.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,961.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,475.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$987.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,672.57
|
| Rate for Payer: Zelis Auto |
$1,579.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,974.50
|
|
|
IMPLT STEM FRACT HUMERAL 15MMX99MM
|
Facility
|
IP
|
$12,150.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7009258
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,860.00 |
| Max. Negotiated Rate |
$11,542.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9,720.00
|
| Rate for Payer: Cash Price |
$7,290.00
|
| Rate for Payer: Cash Price |
$7,290.00
|
| Rate for Payer: Cigna Commercial |
$10,327.50
|
| Rate for Payer: First Health Commercial |
$10,935.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10,935.00
|
| Rate for Payer: GEHA Commercial |
$8,505.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10,935.00
|
| Rate for Payer: Multiplan All |
$11,056.50
|
| Rate for Payer: OMNI Networks Commercial |
$8,505.00
|
| Rate for Payer: One Health Plan PPO/POS |
$10,935.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$11,542.50
|
| Rate for Payer: Three Rivers Provider Network All |
$9,112.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$11,299.50
|
| Rate for Payer: Zelis Auto |
$4,860.00
|
|
|
IMPLT STEM FRACT HUMERAL 15MMX99MM
|
Facility
|
OP
|
$12,150.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7009258
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,037.50 |
| Max. Negotiated Rate |
$11,542.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7,290.00
|
| Rate for Payer: Cash Price |
$7,290.00
|
| Rate for Payer: Cash Price |
$7,290.00
|
| Rate for Payer: Cigna Commercial |
$10,327.50
|
| Rate for Payer: First Health Commercial |
$10,935.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10,935.00
|
| Rate for Payer: GEHA Commercial |
$9,720.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10,935.00
|
| Rate for Payer: Humana ChoiceCare |
$3,159.00
|
| Rate for Payer: Multiplan All |
$11,056.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7,290.00
|
| Rate for Payer: OMNI Networks Commercial |
$8,505.00
|
| Rate for Payer: One Health Plan PPO/POS |
$10,935.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$11,542.50
|
| Rate for Payer: Three Rivers Provider Network All |
$9,112.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10,692.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,037.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$11,299.50
|
| Rate for Payer: Zelis Auto |
$4,860.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,075.00
|
|
|
IMPLT STEM FRACT HUMERAL 8MMX118MM
|
Facility
|
IP
|
$11,925.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002995
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,770.00 |
| Max. Negotiated Rate |
$11,328.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9,540.00
|
| Rate for Payer: Cash Price |
$7,155.00
|
| Rate for Payer: Cash Price |
$7,155.00
|
| Rate for Payer: Cigna Commercial |
$10,136.25
|
| Rate for Payer: First Health Commercial |
$10,732.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10,732.50
|
| Rate for Payer: GEHA Commercial |
$8,347.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10,732.50
|
| Rate for Payer: Multiplan All |
$10,851.75
|
| Rate for Payer: OMNI Networks Commercial |
$8,347.50
|
| Rate for Payer: One Health Plan PPO/POS |
$10,732.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$11,328.75
|
| Rate for Payer: Three Rivers Provider Network All |
$8,943.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$11,090.25
|
| Rate for Payer: Zelis Auto |
$4,770.00
|
|
|
IMPLT STEM FRACT HUMERAL 8MMX118MM
|
Facility
|
OP
|
$11,925.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002995
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,981.25 |
| Max. Negotiated Rate |
$11,328.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7,155.00
|
| Rate for Payer: Cash Price |
$7,155.00
|
| Rate for Payer: Cash Price |
$7,155.00
|
| Rate for Payer: Cigna Commercial |
$10,136.25
|
| Rate for Payer: First Health Commercial |
$10,732.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10,732.50
|
| Rate for Payer: GEHA Commercial |
$9,540.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10,732.50
|
| Rate for Payer: Humana ChoiceCare |
$3,100.50
|
| Rate for Payer: Multiplan All |
$10,851.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7,155.00
|
| Rate for Payer: OMNI Networks Commercial |
$8,347.50
|
| Rate for Payer: One Health Plan PPO/POS |
$10,732.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$11,328.75
|
| Rate for Payer: Three Rivers Provider Network All |
$8,943.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10,494.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,981.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$11,090.25
|
| Rate for Payer: Zelis Auto |
$4,770.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,962.50
|
|
|
IMPLT STEM FRACT HUMERAL 9MMX118MM
|
Facility
|
IP
|
$11,925.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003257
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,770.00 |
| Max. Negotiated Rate |
$11,328.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9,540.00
|
| Rate for Payer: Cash Price |
$7,155.00
|
| Rate for Payer: Cash Price |
$7,155.00
|
| Rate for Payer: Cigna Commercial |
$10,136.25
|
| Rate for Payer: First Health Commercial |
$10,732.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10,732.50
|
| Rate for Payer: GEHA Commercial |
$8,347.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10,732.50
|
| Rate for Payer: Multiplan All |
$10,851.75
|
| Rate for Payer: OMNI Networks Commercial |
$8,347.50
|
| Rate for Payer: One Health Plan PPO/POS |
$10,732.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$11,328.75
|
| Rate for Payer: Three Rivers Provider Network All |
$8,943.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$11,090.25
|
| Rate for Payer: Zelis Auto |
$4,770.00
|
|
|
IMPLT STEM FRACT HUMERAL 9MMX118MM
|
Facility
|
OP
|
$11,925.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003257
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,981.25 |
| Max. Negotiated Rate |
$11,328.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7,155.00
|
| Rate for Payer: Cash Price |
$7,155.00
|
| Rate for Payer: Cash Price |
$7,155.00
|
| Rate for Payer: Cigna Commercial |
$10,136.25
|
| Rate for Payer: First Health Commercial |
$10,732.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10,732.50
|
| Rate for Payer: GEHA Commercial |
$9,540.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10,732.50
|
| Rate for Payer: Humana ChoiceCare |
$3,100.50
|
| Rate for Payer: Multiplan All |
$10,851.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7,155.00
|
| Rate for Payer: OMNI Networks Commercial |
$8,347.50
|
| Rate for Payer: One Health Plan PPO/POS |
$10,732.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$11,328.75
|
| Rate for Payer: Three Rivers Provider Network All |
$8,943.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10,494.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,981.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$11,090.25
|
| Rate for Payer: Zelis Auto |
$4,770.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,962.50
|
|
|
IMPLT STEM FRACT HUMERAL RFX 11X123
|
Facility
|
IP
|
$11,925.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003463
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,770.00 |
| Max. Negotiated Rate |
$11,328.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9,540.00
|
| Rate for Payer: Cash Price |
$7,155.00
|
| Rate for Payer: Cash Price |
$7,155.00
|
| Rate for Payer: Cigna Commercial |
$10,136.25
|
| Rate for Payer: First Health Commercial |
$10,732.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10,732.50
|
| Rate for Payer: GEHA Commercial |
$8,347.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10,732.50
|
| Rate for Payer: Multiplan All |
$10,851.75
|
| Rate for Payer: OMNI Networks Commercial |
$8,347.50
|
| Rate for Payer: One Health Plan PPO/POS |
$10,732.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$11,328.75
|
| Rate for Payer: Three Rivers Provider Network All |
$8,943.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$11,090.25
|
| Rate for Payer: Zelis Auto |
$4,770.00
|
|
|
IMPLT STEM FRACT HUMERAL RFX 11X123
|
Facility
|
OP
|
$11,925.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003463
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,981.25 |
| Max. Negotiated Rate |
$11,328.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7,155.00
|
| Rate for Payer: Cash Price |
$7,155.00
|
| Rate for Payer: Cash Price |
$7,155.00
|
| Rate for Payer: Cigna Commercial |
$10,136.25
|
| Rate for Payer: First Health Commercial |
$10,732.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10,732.50
|
| Rate for Payer: GEHA Commercial |
$9,540.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10,732.50
|
| Rate for Payer: Humana ChoiceCare |
$3,100.50
|
| Rate for Payer: Multiplan All |
$10,851.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7,155.00
|
| Rate for Payer: OMNI Networks Commercial |
$8,347.50
|
| Rate for Payer: One Health Plan PPO/POS |
$10,732.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$11,328.75
|
| Rate for Payer: Three Rivers Provider Network All |
$8,943.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10,494.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,981.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$11,090.25
|
| Rate for Payer: Zelis Auto |
$4,770.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,962.50
|
|
|
IMPLT STEM FRACTURE HUMERAL 8MM
|
Facility
|
OP
|
$17,497.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002568
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,374.25 |
| Max. Negotiated Rate |
$16,622.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$10,498.20
|
| Rate for Payer: Cash Price |
$10,498.20
|
| Rate for Payer: Cash Price |
$10,498.20
|
| Rate for Payer: Cigna Commercial |
$14,872.45
|
| Rate for Payer: First Health Commercial |
$15,747.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$15,747.30
|
| Rate for Payer: GEHA Commercial |
$13,997.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$15,747.30
|
| Rate for Payer: Humana ChoiceCare |
$4,549.22
|
| Rate for Payer: Multiplan All |
$15,922.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10,498.20
|
| Rate for Payer: OMNI Networks Commercial |
$12,247.90
|
| Rate for Payer: One Health Plan PPO/POS |
$15,747.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$16,622.15
|
| Rate for Payer: Three Rivers Provider Network All |
$13,122.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$15,397.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,374.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$16,272.21
|
| Rate for Payer: Zelis Auto |
$6,998.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,748.50
|
|
