|
IMPLT STEM HIP ANGLE NECK 132 SZ 5 35MM
|
Facility
|
OP
|
$7,215.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002151
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,803.75 |
| Max. Negotiated Rate |
$6,854.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,329.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cigna Commercial |
$6,132.75
|
| Rate for Payer: First Health Commercial |
$6,493.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,493.50
|
| Rate for Payer: GEHA Commercial |
$5,772.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,493.50
|
| Rate for Payer: Humana ChoiceCare |
$1,875.90
|
| Rate for Payer: Multiplan All |
$6,565.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,329.00
|
| Rate for Payer: OMNI Networks Commercial |
$5,050.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,493.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,854.25
|
| Rate for Payer: Three Rivers Provider Network All |
$5,411.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,349.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,803.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,709.95
|
| Rate for Payer: Zelis Auto |
$2,886.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,607.50
|
|
|
IMPLT STEM HIP ANGLE NECK 132 SZ 5 35MM
|
Facility
|
IP
|
$7,215.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002151
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,886.00 |
| Max. Negotiated Rate |
$6,854.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,772.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cigna Commercial |
$6,132.75
|
| Rate for Payer: First Health Commercial |
$6,493.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,493.50
|
| Rate for Payer: GEHA Commercial |
$5,050.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,493.50
|
| Rate for Payer: Multiplan All |
$6,565.65
|
| Rate for Payer: OMNI Networks Commercial |
$5,050.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,493.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,854.25
|
| Rate for Payer: Three Rivers Provider Network All |
$5,411.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,709.95
|
| Rate for Payer: Zelis Auto |
$2,886.00
|
|
|
IMPLT STEM HIP ANGLE NECK DEGREE 127
|
Facility
|
IP
|
$7,215.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002152
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,886.00 |
| Max. Negotiated Rate |
$6,854.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,772.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cigna Commercial |
$6,132.75
|
| Rate for Payer: First Health Commercial |
$6,493.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,493.50
|
| Rate for Payer: GEHA Commercial |
$5,050.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,493.50
|
| Rate for Payer: Multiplan All |
$6,565.65
|
| Rate for Payer: OMNI Networks Commercial |
$5,050.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,493.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,854.25
|
| Rate for Payer: Three Rivers Provider Network All |
$5,411.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,709.95
|
| Rate for Payer: Zelis Auto |
$2,886.00
|
|
|
IMPLT STEM HIP ANGLE NECK DEGREE 127
|
Facility
|
IP
|
$8,709.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002153
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,483.60 |
| Max. Negotiated Rate |
$8,273.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,967.20
|
| Rate for Payer: Cash Price |
$5,225.40
|
| Rate for Payer: Cash Price |
$5,225.40
|
| Rate for Payer: Cigna Commercial |
$7,402.65
|
| Rate for Payer: First Health Commercial |
$7,838.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,838.10
|
| Rate for Payer: GEHA Commercial |
$6,096.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,838.10
|
| Rate for Payer: Multiplan All |
$7,925.19
|
| Rate for Payer: OMNI Networks Commercial |
$6,096.30
|
| Rate for Payer: One Health Plan PPO/POS |
$7,838.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,273.55
|
| Rate for Payer: Three Rivers Provider Network All |
$6,531.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,099.37
|
| Rate for Payer: Zelis Auto |
$3,483.60
|
|
|
IMPLT STEM HIP ANGLE NECK DEGREE 127
|
Facility
|
OP
|
$7,215.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002152
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,803.75 |
| Max. Negotiated Rate |
$6,854.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,329.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cigna Commercial |
$6,132.75
|
| Rate for Payer: First Health Commercial |
$6,493.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,493.50
|
| Rate for Payer: GEHA Commercial |
$5,772.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,493.50
|
| Rate for Payer: Humana ChoiceCare |
$1,875.90
|
| Rate for Payer: Multiplan All |
$6,565.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,329.00
|
| Rate for Payer: OMNI Networks Commercial |
$5,050.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,493.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,854.25
|
| Rate for Payer: Three Rivers Provider Network All |
$5,411.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,349.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,803.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,709.95
|
| Rate for Payer: Zelis Auto |
$2,886.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,607.50
|
|
|
IMPLT STEM HIP ANGLE NECK DEGREE 127
|
Facility
|
OP
|
$8,709.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002153
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,177.25 |
| Max. Negotiated Rate |
$8,273.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,225.40
|
| Rate for Payer: Cash Price |
$5,225.40
|
| Rate for Payer: Cash Price |
$5,225.40
|
| Rate for Payer: Cigna Commercial |
$7,402.65
|
| Rate for Payer: First Health Commercial |
$7,838.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,838.10
|
| Rate for Payer: GEHA Commercial |
$6,967.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,838.10
|
| Rate for Payer: Humana ChoiceCare |
$2,264.34
|
| Rate for Payer: Multiplan All |
$7,925.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,225.40
|
| Rate for Payer: OMNI Networks Commercial |
$6,096.30
|
| Rate for Payer: One Health Plan PPO/POS |
$7,838.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,273.55
|
| Rate for Payer: Three Rivers Provider Network All |
$6,531.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,663.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,177.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,099.37
|
| Rate for Payer: Zelis Auto |
$3,483.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,354.50
|
|
|
IMPLT STEM HIP ANGLE NECK DEGREE 127
|
Facility
|
OP
|
$7,108.41
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7009248
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,777.10 |
| Max. Negotiated Rate |
$6,752.99 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,265.05
|
| Rate for Payer: Cash Price |
$4,265.05
|
| Rate for Payer: Cash Price |
$4,265.05
|
| Rate for Payer: Cigna Commercial |
$6,042.15
|
| Rate for Payer: First Health Commercial |
$6,397.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,397.57
|
| Rate for Payer: GEHA Commercial |
$5,686.73
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,397.57
|
| Rate for Payer: Humana ChoiceCare |
$1,848.19
|
| Rate for Payer: Multiplan All |
$6,468.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,265.05
|
| Rate for Payer: OMNI Networks Commercial |
$4,975.89
|
| Rate for Payer: One Health Plan PPO/POS |
$6,397.57
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,752.99
|
| Rate for Payer: Three Rivers Provider Network All |
$5,331.31
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,255.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,777.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,610.82
|
| Rate for Payer: Zelis Auto |
$2,843.36
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,554.20
|
|
|
IMPLT STEM HIP ANGLE NECK DEGREE 127
|
Facility
|
IP
|
$7,108.41
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7009248
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,843.36 |
| Max. Negotiated Rate |
$6,752.99 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,686.73
|
| Rate for Payer: Cash Price |
$4,265.05
|
| Rate for Payer: Cash Price |
$4,265.05
|
| Rate for Payer: Cigna Commercial |
$6,042.15
|
| Rate for Payer: First Health Commercial |
$6,397.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,397.57
|
| Rate for Payer: GEHA Commercial |
$4,975.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,397.57
|
| Rate for Payer: Multiplan All |
$6,468.65
|
| Rate for Payer: OMNI Networks Commercial |
$4,975.89
|
| Rate for Payer: One Health Plan PPO/POS |
$6,397.57
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,752.99
|
| Rate for Payer: Three Rivers Provider Network All |
$5,331.31
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,610.82
|
| Rate for Payer: Zelis Auto |
$2,843.36
|
|
|
IMPLT STEM HIP ANGLE NECK DEGREE 132 #8
|
Facility
|
IP
|
$7,215.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002545
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,886.00 |
| Max. Negotiated Rate |
$6,854.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,772.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cigna Commercial |
$6,132.75
|
| Rate for Payer: First Health Commercial |
$6,493.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,493.50
|
| Rate for Payer: GEHA Commercial |
$5,050.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,493.50
|
| Rate for Payer: Multiplan All |
$6,565.65
|
| Rate for Payer: OMNI Networks Commercial |
$5,050.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,493.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,854.25
|
| Rate for Payer: Three Rivers Provider Network All |
$5,411.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,709.95
|
| Rate for Payer: Zelis Auto |
$2,886.00
|
|
|
IMPLT STEM HIP ANGLE NECK DEGREE 132 #8
|
Facility
|
OP
|
$7,215.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002545
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,803.75 |
| Max. Negotiated Rate |
$6,854.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,329.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cigna Commercial |
$6,132.75
|
| Rate for Payer: First Health Commercial |
$6,493.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,493.50
|
| Rate for Payer: GEHA Commercial |
$5,772.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,493.50
|
| Rate for Payer: Humana ChoiceCare |
$1,875.90
|
| Rate for Payer: Multiplan All |
$6,565.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,329.00
|
| Rate for Payer: OMNI Networks Commercial |
$5,050.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,493.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,854.25
|
| Rate for Payer: Three Rivers Provider Network All |
$5,411.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,349.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,803.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,709.95
|
| Rate for Payer: Zelis Auto |
$2,886.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,607.50
|
|
|
IMPLT STEM HIP CEMENTED OFFSET 37.5
|
Facility
|
OP
|
$5,557.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002154
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,389.25 |
| Max. Negotiated Rate |
$5,279.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,334.20
|
| Rate for Payer: Cash Price |
$3,334.20
|
| Rate for Payer: Cash Price |
$3,334.20
|
| Rate for Payer: Cigna Commercial |
$4,723.45
|
| Rate for Payer: First Health Commercial |
$5,001.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,001.30
|
| Rate for Payer: GEHA Commercial |
$4,445.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,001.30
|
| Rate for Payer: Humana ChoiceCare |
$1,444.82
|
| Rate for Payer: Multiplan All |
$5,056.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,334.20
|
| Rate for Payer: OMNI Networks Commercial |
$3,889.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,001.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,279.15
|
| Rate for Payer: Three Rivers Provider Network All |
$4,167.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,890.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,389.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,168.01
|
| Rate for Payer: Zelis Auto |
$2,222.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,778.50
|
|
|
IMPLT STEM HIP CEMENTED OFFSET 37.5
|
Facility
|
IP
|
$5,557.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002154
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,222.80 |
| Max. Negotiated Rate |
$5,279.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,445.60
|
| Rate for Payer: Cash Price |
$3,334.20
|
| Rate for Payer: Cash Price |
$3,334.20
|
| Rate for Payer: Cigna Commercial |
$4,723.45
|
| Rate for Payer: First Health Commercial |
$5,001.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,001.30
|
| Rate for Payer: GEHA Commercial |
$3,889.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,001.30
|
| Rate for Payer: Multiplan All |
$5,056.87
|
| Rate for Payer: OMNI Networks Commercial |
$3,889.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,001.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,279.15
|
| Rate for Payer: Three Rivers Provider Network All |
$4,167.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,168.01
|
| Rate for Payer: Zelis Auto |
$2,222.80
|
|
|
IMPLT STEM HIP CEMENTED OFFSET 44 SIZE 0
|
Facility
|
OP
|
$5,557.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006443
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,389.25 |
| Max. Negotiated Rate |
$5,279.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,334.20
|
| Rate for Payer: Cash Price |
$3,334.20
|
| Rate for Payer: Cash Price |
$3,334.20
|
| Rate for Payer: Cigna Commercial |
$4,723.45
|
| Rate for Payer: First Health Commercial |
$5,001.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,001.30
|
| Rate for Payer: GEHA Commercial |
$4,445.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,001.30
|
| Rate for Payer: Humana ChoiceCare |
$1,444.82
|
| Rate for Payer: Multiplan All |
$5,056.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,334.20
|
| Rate for Payer: OMNI Networks Commercial |
$3,889.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,001.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,279.15
|
| Rate for Payer: Three Rivers Provider Network All |
$4,167.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,890.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,389.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,168.01
|
| Rate for Payer: Zelis Auto |
$2,222.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,778.50
|
|
|
IMPLT STEM HIP CEMENTED OFFSET 44 SIZE 0
|
Facility
|
IP
|
$5,557.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006443
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,222.80 |
| Max. Negotiated Rate |
$5,279.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,445.60
|
| Rate for Payer: Cash Price |
$3,334.20
|
| Rate for Payer: Cash Price |
$3,334.20
|
| Rate for Payer: Cigna Commercial |
$4,723.45
|
| Rate for Payer: First Health Commercial |
$5,001.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,001.30
|
| Rate for Payer: GEHA Commercial |
$3,889.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,001.30
|
| Rate for Payer: Multiplan All |
$5,056.87
|
| Rate for Payer: OMNI Networks Commercial |
$3,889.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,001.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,279.15
|
| Rate for Payer: Three Rivers Provider Network All |
$4,167.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,168.01
|
| Rate for Payer: Zelis Auto |
$2,222.80
|
|
|
IMPLT STEM HIP CEMENTED OFFSET 44 SIZE 3
|
Facility
|
OP
|
$5,557.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006419
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,389.25 |
| Max. Negotiated Rate |
$5,279.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,334.20
|
| Rate for Payer: Cash Price |
$3,334.20
|
| Rate for Payer: Cash Price |
$3,334.20
|
| Rate for Payer: Cigna Commercial |
$4,723.45
|
| Rate for Payer: First Health Commercial |
$5,001.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,001.30
|
| Rate for Payer: GEHA Commercial |
$4,445.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,001.30
|
| Rate for Payer: Humana ChoiceCare |
$1,444.82
|
| Rate for Payer: Multiplan All |
$5,056.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,334.20
|
| Rate for Payer: OMNI Networks Commercial |
$3,889.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,001.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,279.15
|
| Rate for Payer: Three Rivers Provider Network All |
$4,167.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,890.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,389.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,168.01
|
| Rate for Payer: Zelis Auto |
$2,222.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,778.50
|
|
|
IMPLT STEM HIP CEMENTED OFFSET 44 SIZE 3
|
Facility
|
IP
|
$5,557.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006419
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,222.80 |
| Max. Negotiated Rate |
$5,279.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,445.60
|
| Rate for Payer: Cash Price |
$3,334.20
|
| Rate for Payer: Cash Price |
$3,334.20
|
| Rate for Payer: Cigna Commercial |
$4,723.45
|
| Rate for Payer: First Health Commercial |
$5,001.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,001.30
|
| Rate for Payer: GEHA Commercial |
$3,889.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,001.30
|
| Rate for Payer: Multiplan All |
$5,056.87
|
| Rate for Payer: OMNI Networks Commercial |
$3,889.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,001.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,279.15
|
| Rate for Payer: Three Rivers Provider Network All |
$4,167.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,168.01
|
| Rate for Payer: Zelis Auto |
$2,222.80
|
|
|
IMPLT STEM HIP CEMENTED V40 EXETER 37.5
|
Facility
|
IP
|
$5,557.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,222.80 |
| Max. Negotiated Rate |
$5,279.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,445.60
|
| Rate for Payer: Cash Price |
$3,334.20
|
| Rate for Payer: Cash Price |
$3,334.20
|
| Rate for Payer: Cigna Commercial |
$4,723.45
|
| Rate for Payer: First Health Commercial |
$5,001.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,001.30
|
| Rate for Payer: GEHA Commercial |
$3,889.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,001.30
|
| Rate for Payer: Multiplan All |
$5,056.87
|
| Rate for Payer: OMNI Networks Commercial |
$3,889.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,001.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,279.15
|
| Rate for Payer: Three Rivers Provider Network All |
$4,167.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,168.01
|
| Rate for Payer: Zelis Auto |
$2,222.80
|
|
|
IMPLT STEM HIP CEMENTED V40 EXETER 37.5
|
Facility
|
OP
|
$5,557.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,389.25 |
| Max. Negotiated Rate |
$5,279.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,334.20
|
| Rate for Payer: Cash Price |
$3,334.20
|
| Rate for Payer: Cash Price |
$3,334.20
|
| Rate for Payer: Cigna Commercial |
$4,723.45
|
| Rate for Payer: First Health Commercial |
$5,001.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,001.30
|
| Rate for Payer: GEHA Commercial |
$4,445.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,001.30
|
| Rate for Payer: Humana ChoiceCare |
$1,444.82
|
| Rate for Payer: Multiplan All |
$5,056.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,334.20
|
| Rate for Payer: OMNI Networks Commercial |
$3,889.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,001.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,279.15
|
| Rate for Payer: Three Rivers Provider Network All |
$4,167.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,890.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,389.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,168.01
|
| Rate for Payer: Zelis Auto |
$2,222.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,778.50
|
|
|
IMPLT STEM HIP DEGREE 132 DEGREE SZ 7
|
Facility
|
OP
|
$7,215.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002155
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,803.75 |
| Max. Negotiated Rate |
$6,854.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,329.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cigna Commercial |
$6,132.75
|
| Rate for Payer: First Health Commercial |
$6,493.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,493.50
|
| Rate for Payer: GEHA Commercial |
$5,772.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,493.50
|
| Rate for Payer: Humana ChoiceCare |
$1,875.90
|
| Rate for Payer: Multiplan All |
$6,565.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,329.00
|
| Rate for Payer: OMNI Networks Commercial |
$5,050.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,493.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,854.25
|
| Rate for Payer: Three Rivers Provider Network All |
$5,411.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,349.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,803.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,709.95
|
| Rate for Payer: Zelis Auto |
$2,886.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,607.50
|
|
|
IMPLT STEM HIP DEGREE 132 DEGREE SZ 7
|
Facility
|
IP
|
$7,215.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002155
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,886.00 |
| Max. Negotiated Rate |
$6,854.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,772.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cigna Commercial |
$6,132.75
|
| Rate for Payer: First Health Commercial |
$6,493.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,493.50
|
| Rate for Payer: GEHA Commercial |
$5,050.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,493.50
|
| Rate for Payer: Multiplan All |
$6,565.65
|
| Rate for Payer: OMNI Networks Commercial |
$5,050.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,493.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,854.25
|
| Rate for Payer: Three Rivers Provider Network All |
$5,411.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,709.95
|
| Rate for Payer: Zelis Auto |
$2,886.00
|
|
|
IMPLT STEM HIP NECK ANGLE 9 SIZE
|
Facility
|
OP
|
$8,709.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006588
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,177.25 |
| Max. Negotiated Rate |
$8,273.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,225.40
|
| Rate for Payer: Cash Price |
$5,225.40
|
| Rate for Payer: Cash Price |
$5,225.40
|
| Rate for Payer: Cigna Commercial |
$7,402.65
|
| Rate for Payer: First Health Commercial |
$7,838.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,838.10
|
| Rate for Payer: GEHA Commercial |
$6,967.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,838.10
|
| Rate for Payer: Humana ChoiceCare |
$2,264.34
|
| Rate for Payer: Multiplan All |
$7,925.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,225.40
|
| Rate for Payer: OMNI Networks Commercial |
$6,096.30
|
| Rate for Payer: One Health Plan PPO/POS |
$7,838.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,273.55
|
| Rate for Payer: Three Rivers Provider Network All |
$6,531.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,663.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,177.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,099.37
|
| Rate for Payer: Zelis Auto |
$3,483.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,354.50
|
|
|
IMPLT STEM HIP NECK ANGLE 9 SIZE
|
Facility
|
IP
|
$8,709.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006588
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,483.60 |
| Max. Negotiated Rate |
$8,273.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,967.20
|
| Rate for Payer: Cash Price |
$5,225.40
|
| Rate for Payer: Cash Price |
$5,225.40
|
| Rate for Payer: Cigna Commercial |
$7,402.65
|
| Rate for Payer: First Health Commercial |
$7,838.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,838.10
|
| Rate for Payer: GEHA Commercial |
$6,096.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,838.10
|
| Rate for Payer: Multiplan All |
$7,925.19
|
| Rate for Payer: OMNI Networks Commercial |
$6,096.30
|
| Rate for Payer: One Health Plan PPO/POS |
$7,838.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,273.55
|
| Rate for Payer: Three Rivers Provider Network All |
$6,531.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,099.37
|
| Rate for Payer: Zelis Auto |
$3,483.60
|
|
|
IMPLT STEM HIP NECK ANGLE DEGREE 127
|
Facility
|
OP
|
$7,215.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002156
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,803.75 |
| Max. Negotiated Rate |
$6,854.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,329.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cigna Commercial |
$6,132.75
|
| Rate for Payer: First Health Commercial |
$6,493.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,493.50
|
| Rate for Payer: GEHA Commercial |
$5,772.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,493.50
|
| Rate for Payer: Humana ChoiceCare |
$1,875.90
|
| Rate for Payer: Multiplan All |
$6,565.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,329.00
|
| Rate for Payer: OMNI Networks Commercial |
$5,050.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,493.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,854.25
|
| Rate for Payer: Three Rivers Provider Network All |
$5,411.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,349.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,803.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,709.95
|
| Rate for Payer: Zelis Auto |
$2,886.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,607.50
|
|
|
IMPLT STEM HIP NECK ANGLE DEGREE 127
|
Facility
|
IP
|
$7,215.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002156
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,886.00 |
| Max. Negotiated Rate |
$6,854.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,772.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cigna Commercial |
$6,132.75
|
| Rate for Payer: First Health Commercial |
$6,493.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,493.50
|
| Rate for Payer: GEHA Commercial |
$5,050.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,493.50
|
| Rate for Payer: Multiplan All |
$6,565.65
|
| Rate for Payer: OMNI Networks Commercial |
$5,050.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,493.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,854.25
|
| Rate for Payer: Three Rivers Provider Network All |
$5,411.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,709.95
|
| Rate for Payer: Zelis Auto |
$2,886.00
|
|
|
IMPLT STEM HIP OFFSET SIZE 6
|
Facility
|
IP
|
$4,598.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002288
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,839.20 |
| Max. Negotiated Rate |
$4,368.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,678.40
|
| Rate for Payer: Cash Price |
$2,758.80
|
| Rate for Payer: Cash Price |
$2,758.80
|
| Rate for Payer: Cigna Commercial |
$3,908.30
|
| Rate for Payer: First Health Commercial |
$4,138.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,138.20
|
| Rate for Payer: GEHA Commercial |
$3,218.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,138.20
|
| Rate for Payer: Multiplan All |
$4,184.18
|
| Rate for Payer: OMNI Networks Commercial |
$3,218.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,138.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,368.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,448.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,276.14
|
| Rate for Payer: Zelis Auto |
$1,839.20
|
|
