|
IMPLT STEM HIP OFFSET SIZE 6
|
Facility
|
OP
|
$4,598.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002288
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,149.50 |
| Max. Negotiated Rate |
$4,368.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,758.80
|
| 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 |
$3,678.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,138.20
|
| Rate for Payer: Humana ChoiceCare |
$1,195.48
|
| Rate for Payer: Multiplan All |
$4,184.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,758.80
|
| 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: TriWest Veterans Administration/VAPC3 |
$4,046.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,149.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,276.14
|
| Rate for Payer: Zelis Auto |
$1,839.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,299.00
|
|
|
IMPLT STEM HIP OMNIFIT
|
Facility
|
OP
|
$4,598.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002301
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,149.50 |
| Max. Negotiated Rate |
$4,368.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,758.80
|
| 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 |
$3,678.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,138.20
|
| Rate for Payer: Humana ChoiceCare |
$1,195.48
|
| Rate for Payer: Multiplan All |
$4,184.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,758.80
|
| 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: TriWest Veterans Administration/VAPC3 |
$4,046.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,149.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,276.14
|
| Rate for Payer: Zelis Auto |
$1,839.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,299.00
|
|
|
IMPLT STEM HIP OMNIFIT
|
Facility
|
IP
|
$4,598.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002301
|
|
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
|
|
|
IMPLT STEM HIP SIZE 6 28MMX120MM
|
Facility
|
OP
|
$9,318.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002302
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,329.50 |
| Max. Negotiated Rate |
$8,852.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,590.80
|
| Rate for Payer: Cash Price |
$5,590.80
|
| Rate for Payer: Cash Price |
$5,590.80
|
| Rate for Payer: Cigna Commercial |
$7,920.30
|
| Rate for Payer: First Health Commercial |
$8,386.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,386.20
|
| Rate for Payer: GEHA Commercial |
$7,454.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,386.20
|
| Rate for Payer: Humana ChoiceCare |
$2,422.68
|
| Rate for Payer: Multiplan All |
$8,479.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,590.80
|
| Rate for Payer: OMNI Networks Commercial |
$6,522.60
|
| Rate for Payer: One Health Plan PPO/POS |
$8,386.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,852.10
|
| Rate for Payer: Three Rivers Provider Network All |
$6,988.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8,199.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,329.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,665.74
|
| Rate for Payer: Zelis Auto |
$3,727.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,659.00
|
|
|
IMPLT STEM HIP SIZE 6 28MMX120MM
|
Facility
|
IP
|
$9,318.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002302
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,727.20 |
| Max. Negotiated Rate |
$8,852.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7,454.40
|
| Rate for Payer: Cash Price |
$5,590.80
|
| Rate for Payer: Cash Price |
$5,590.80
|
| Rate for Payer: Cigna Commercial |
$7,920.30
|
| Rate for Payer: First Health Commercial |
$8,386.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,386.20
|
| Rate for Payer: GEHA Commercial |
$6,522.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,386.20
|
| Rate for Payer: Multiplan All |
$8,479.38
|
| Rate for Payer: OMNI Networks Commercial |
$6,522.60
|
| Rate for Payer: One Health Plan PPO/POS |
$8,386.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,852.10
|
| Rate for Payer: Three Rivers Provider Network All |
$6,988.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,665.74
|
| Rate for Payer: Zelis Auto |
$3,727.20
|
|
|
IMPLT STEM HIP SIZE 8 30MM 132 DEG.
|
Facility
|
OP
|
$5,024.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002303
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,256.00 |
| Max. Negotiated Rate |
$4,772.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,014.40
|
| Rate for Payer: Cash Price |
$3,014.40
|
| Rate for Payer: Cash Price |
$3,014.40
|
| Rate for Payer: Cigna Commercial |
$4,270.40
|
| Rate for Payer: First Health Commercial |
$4,521.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,521.60
|
| Rate for Payer: GEHA Commercial |
$4,019.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,521.60
|
| Rate for Payer: Humana ChoiceCare |
$1,306.24
|
| Rate for Payer: Multiplan All |
$4,571.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,014.40
|
| Rate for Payer: OMNI Networks Commercial |
$3,516.80
|
| Rate for Payer: One Health Plan PPO/POS |
$4,521.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,772.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3,768.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,421.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,256.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,672.32
|
| Rate for Payer: Zelis Auto |
$2,009.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,512.00
|
|
|
IMPLT STEM HIP SIZE 8 30MM 132 DEG.
|
Facility
|
IP
|
$5,024.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002303
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,009.60 |
| Max. Negotiated Rate |
$4,772.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,019.20
|
| Rate for Payer: Cash Price |
$3,014.40
|
| Rate for Payer: Cash Price |
$3,014.40
|
| Rate for Payer: Cigna Commercial |
$4,270.40
|
| Rate for Payer: First Health Commercial |
$4,521.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,521.60
|
| Rate for Payer: GEHA Commercial |
$3,516.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,521.60
|
| Rate for Payer: Multiplan All |
$4,571.84
|
| Rate for Payer: OMNI Networks Commercial |
$3,516.80
|
| Rate for Payer: One Health Plan PPO/POS |
$4,521.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,772.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3,768.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,672.32
|
| Rate for Payer: Zelis Auto |
$2,009.60
|
|
|
IMPLT STEM HUMERAL 12X145MM
|
Facility
|
OP
|
$9,458.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002306
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,364.50 |
| Max. Negotiated Rate |
$8,985.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,674.80
|
| Rate for Payer: Cash Price |
$5,674.80
|
| Rate for Payer: Cash Price |
$5,674.80
|
| Rate for Payer: Cigna Commercial |
$8,039.30
|
| Rate for Payer: First Health Commercial |
$8,512.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,512.20
|
| Rate for Payer: GEHA Commercial |
$7,566.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,512.20
|
| Rate for Payer: Humana ChoiceCare |
$2,459.08
|
| Rate for Payer: Multiplan All |
$8,606.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,674.80
|
| Rate for Payer: OMNI Networks Commercial |
$6,620.60
|
| Rate for Payer: One Health Plan PPO/POS |
$8,512.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,985.10
|
| Rate for Payer: Three Rivers Provider Network All |
$7,093.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8,323.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,364.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,795.94
|
| Rate for Payer: Zelis Auto |
$3,783.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,729.00
|
|
|
IMPLT STEM HUMERAL 12X145MM
|
Facility
|
IP
|
$9,458.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002306
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,783.20 |
| Max. Negotiated Rate |
$8,985.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7,566.40
|
| Rate for Payer: Cash Price |
$5,674.80
|
| Rate for Payer: Cash Price |
$5,674.80
|
| Rate for Payer: Cigna Commercial |
$8,039.30
|
| Rate for Payer: First Health Commercial |
$8,512.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,512.20
|
| Rate for Payer: GEHA Commercial |
$6,620.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,512.20
|
| Rate for Payer: Multiplan All |
$8,606.78
|
| Rate for Payer: OMNI Networks Commercial |
$6,620.60
|
| Rate for Payer: One Health Plan PPO/POS |
$8,512.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,985.10
|
| Rate for Payer: Three Rivers Provider Network All |
$7,093.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,795.94
|
| Rate for Payer: Zelis Auto |
$3,783.20
|
|
|
IMPLT STEM HUMERAL MINI 10MM
|
Facility
|
OP
|
$17,320.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002157
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,330.00 |
| Max. Negotiated Rate |
$16,454.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$10,392.00
|
| Rate for Payer: Cash Price |
$10,392.00
|
| Rate for Payer: Cash Price |
$10,392.00
|
| Rate for Payer: Cigna Commercial |
$14,722.00
|
| Rate for Payer: First Health Commercial |
$15,588.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$15,588.00
|
| Rate for Payer: GEHA Commercial |
$13,856.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$15,588.00
|
| Rate for Payer: Humana ChoiceCare |
$4,503.20
|
| Rate for Payer: Multiplan All |
$15,761.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10,392.00
|
| Rate for Payer: OMNI Networks Commercial |
$12,124.00
|
| Rate for Payer: One Health Plan PPO/POS |
$15,588.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$16,454.00
|
| Rate for Payer: Three Rivers Provider Network All |
$12,990.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$15,241.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,330.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$16,107.60
|
| Rate for Payer: Zelis Auto |
$6,928.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,660.00
|
|
|
IMPLT STEM HUMERAL MINI 10MM
|
Facility
|
IP
|
$17,320.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002157
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,928.00 |
| Max. Negotiated Rate |
$16,454.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$13,856.00
|
| Rate for Payer: Cash Price |
$10,392.00
|
| Rate for Payer: Cash Price |
$10,392.00
|
| Rate for Payer: Cigna Commercial |
$14,722.00
|
| Rate for Payer: First Health Commercial |
$15,588.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$15,588.00
|
| Rate for Payer: GEHA Commercial |
$12,124.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$15,588.00
|
| Rate for Payer: Multiplan All |
$15,761.20
|
| Rate for Payer: OMNI Networks Commercial |
$12,124.00
|
| Rate for Payer: One Health Plan PPO/POS |
$15,588.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$16,454.00
|
| Rate for Payer: Three Rivers Provider Network All |
$12,990.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$16,107.60
|
| Rate for Payer: Zelis Auto |
$6,928.00
|
|
|
IMPLT STEM HUMERAL MODULAR 12 SIZE
|
Facility
|
OP
|
$11,925.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002604
|
|
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 HUMERAL MODULAR 12 SIZE
|
Facility
|
IP
|
$11,925.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002604
|
|
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 HUMERAL MODULAR SIZE 11
|
Facility
|
IP
|
$11,925.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002304
|
|
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 HUMERAL MODULAR SIZE 11
|
Facility
|
OP
|
$11,925.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002304
|
|
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 HUMERAL MODULAR SIZE 14
|
Facility
|
OP
|
$20,447.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002305
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,111.75 |
| Max. Negotiated Rate |
$19,424.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$12,268.20
|
| Rate for Payer: Cash Price |
$12,268.20
|
| Rate for Payer: Cash Price |
$12,268.20
|
| Rate for Payer: Cigna Commercial |
$17,379.95
|
| Rate for Payer: First Health Commercial |
$18,402.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$18,402.30
|
| Rate for Payer: GEHA Commercial |
$16,357.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$18,402.30
|
| Rate for Payer: Humana ChoiceCare |
$5,316.22
|
| Rate for Payer: Multiplan All |
$18,606.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$12,268.20
|
| Rate for Payer: OMNI Networks Commercial |
$14,312.90
|
| Rate for Payer: One Health Plan PPO/POS |
$18,402.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$19,424.65
|
| Rate for Payer: Three Rivers Provider Network All |
$15,335.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17,993.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,111.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$19,015.71
|
| Rate for Payer: Zelis Auto |
$8,178.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10,223.50
|
|
|
IMPLT STEM HUMERAL MODULAR SIZE 14
|
Facility
|
IP
|
$20,447.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002305
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,178.80 |
| Max. Negotiated Rate |
$19,424.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$16,357.60
|
| Rate for Payer: Cash Price |
$12,268.20
|
| Rate for Payer: Cash Price |
$12,268.20
|
| Rate for Payer: Cigna Commercial |
$17,379.95
|
| Rate for Payer: First Health Commercial |
$18,402.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$18,402.30
|
| Rate for Payer: GEHA Commercial |
$14,312.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$18,402.30
|
| Rate for Payer: Multiplan All |
$18,606.77
|
| Rate for Payer: OMNI Networks Commercial |
$14,312.90
|
| Rate for Payer: One Health Plan PPO/POS |
$18,402.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$19,424.65
|
| Rate for Payer: Three Rivers Provider Network All |
$15,335.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$19,015.71
|
| Rate for Payer: Zelis Auto |
$8,178.80
|
|
|
IMPLT STEM HUMERAL MODULAR SIZE 14X133MM
|
Facility
|
IP
|
$11,925.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002158
|
|
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 HUMERAL MODULAR SIZE 14X133MM
|
Facility
|
OP
|
$11,925.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002158
|
|
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 HUMERAL MODULAR SIZE 15
|
Facility
|
OP
|
$11,925.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002773
|
|
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 HUMERAL MODULAR SIZE 15
|
Facility
|
IP
|
$11,925.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002773
|
|
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 HUMERAL MODULAR SIZE 16
|
Facility
|
IP
|
$11,925.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002614
|
|
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 HUMERAL MODULAR SIZE 16
|
Facility
|
OP
|
$11,925.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002614
|
|
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 HUMERAL MODULAR SIZE 17
|
Facility
|
IP
|
$11,925.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002706
|
|
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 HUMERAL MODULAR SIZE 17
|
Facility
|
OP
|
$11,925.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002706
|
|
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
|
|
