|
IMPLT STEM HUMERAL SIZE10 123MM
|
Facility
|
IP
|
$11,925.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002166
|
|
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 SIZE10 123MM
|
Facility
|
OP
|
$11,925.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002166
|
|
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 SIZE 8
|
Facility
|
OP
|
$11,925.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009033
|
|
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 SIZE 8
|
Facility
|
IP
|
$11,925.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009033
|
|
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 SIZE 9 118MM
|
Facility
|
OP
|
$11,925.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003131
|
|
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 SIZE 9 118MM
|
Facility
|
IP
|
$11,925.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003131
|
|
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 INTEGRAL CENTRALIZER11MM
|
Facility
|
IP
|
$9,543.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002307
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,817.20 |
| Max. Negotiated Rate |
$9,065.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7,634.40
|
| Rate for Payer: Cash Price |
$5,725.80
|
| Rate for Payer: Cash Price |
$5,725.80
|
| Rate for Payer: Cigna Commercial |
$8,111.55
|
| Rate for Payer: First Health Commercial |
$8,588.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,588.70
|
| Rate for Payer: GEHA Commercial |
$6,680.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,588.70
|
| Rate for Payer: Multiplan All |
$8,684.13
|
| Rate for Payer: OMNI Networks Commercial |
$6,680.10
|
| Rate for Payer: One Health Plan PPO/POS |
$8,588.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9,065.85
|
| Rate for Payer: Three Rivers Provider Network All |
$7,157.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,874.99
|
| Rate for Payer: Zelis Auto |
$3,817.20
|
|
|
IMPLT STEM INTEGRAL CENTRALIZER11MM
|
Facility
|
OP
|
$9,543.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002307
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,385.75 |
| Max. Negotiated Rate |
$9,065.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,725.80
|
| Rate for Payer: Cash Price |
$5,725.80
|
| Rate for Payer: Cash Price |
$5,725.80
|
| Rate for Payer: Cigna Commercial |
$8,111.55
|
| Rate for Payer: First Health Commercial |
$8,588.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,588.70
|
| Rate for Payer: GEHA Commercial |
$7,634.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,588.70
|
| Rate for Payer: Humana ChoiceCare |
$2,481.18
|
| Rate for Payer: Multiplan All |
$8,684.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,725.80
|
| Rate for Payer: OMNI Networks Commercial |
$6,680.10
|
| Rate for Payer: One Health Plan PPO/POS |
$8,588.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9,065.85
|
| Rate for Payer: Three Rivers Provider Network All |
$7,157.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8,397.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,385.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,874.99
|
| Rate for Payer: Zelis Auto |
$3,817.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,771.50
|
|
|
IMPLT STEM MINI COMPREHENSIVE 11X83
|
Facility
|
OP
|
$17,320.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002167
|
|
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 MINI COMPREHENSIVE 11X83
|
Facility
|
IP
|
$17,320.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002167
|
|
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 MINI COMPREHENSIVE 14X83
|
Facility
|
OP
|
$6,291.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002308
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,572.75 |
| Max. Negotiated Rate |
$5,976.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,774.60
|
| Rate for Payer: Cash Price |
$3,774.60
|
| Rate for Payer: Cash Price |
$3,774.60
|
| Rate for Payer: Cigna Commercial |
$5,347.35
|
| Rate for Payer: First Health Commercial |
$5,661.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,661.90
|
| Rate for Payer: GEHA Commercial |
$5,032.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,661.90
|
| Rate for Payer: Humana ChoiceCare |
$1,635.66
|
| Rate for Payer: Multiplan All |
$5,724.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,774.60
|
| Rate for Payer: OMNI Networks Commercial |
$4,403.70
|
| Rate for Payer: One Health Plan PPO/POS |
$5,661.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,976.45
|
| Rate for Payer: Three Rivers Provider Network All |
$4,718.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,536.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,572.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,850.63
|
| Rate for Payer: Zelis Auto |
$2,516.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,145.50
|
|
|
IMPLT STEM MINI COMPREHENSIVE 14X83
|
Facility
|
IP
|
$6,291.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002308
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,516.40 |
| Max. Negotiated Rate |
$5,976.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,032.80
|
| Rate for Payer: Cash Price |
$3,774.60
|
| Rate for Payer: Cash Price |
$3,774.60
|
| Rate for Payer: Cigna Commercial |
$5,347.35
|
| Rate for Payer: First Health Commercial |
$5,661.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,661.90
|
| Rate for Payer: GEHA Commercial |
$4,403.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,661.90
|
| Rate for Payer: Multiplan All |
$5,724.81
|
| Rate for Payer: OMNI Networks Commercial |
$4,403.70
|
| Rate for Payer: One Health Plan PPO/POS |
$5,661.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,976.45
|
| Rate for Payer: Three Rivers Provider Network All |
$4,718.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,850.63
|
| Rate for Payer: Zelis Auto |
$2,516.40
|
|
|
IMPLT STEM MODULAR HUMERAL 13 SIZE
|
Facility
|
IP
|
$11,925.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002598
|
|
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 MODULAR HUMERAL 13 SIZE
|
Facility
|
OP
|
$11,925.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002598
|
|
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 MOLD HIP W/REINF 9X125
|
Facility
|
OP
|
$4,945.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002937
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,236.25 |
| Max. Negotiated Rate |
$4,697.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,967.00
|
| Rate for Payer: Cash Price |
$2,967.00
|
| Rate for Payer: Cash Price |
$2,967.00
|
| Rate for Payer: Cigna Commercial |
$4,203.25
|
| Rate for Payer: First Health Commercial |
$4,450.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,450.50
|
| Rate for Payer: GEHA Commercial |
$3,956.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,450.50
|
| Rate for Payer: Humana ChoiceCare |
$1,285.70
|
| Rate for Payer: Multiplan All |
$4,499.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,967.00
|
| Rate for Payer: OMNI Networks Commercial |
$3,461.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4,450.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,697.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3,708.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,351.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,236.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,598.85
|
| Rate for Payer: Zelis Auto |
$1,978.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,472.50
|
|
|
IMPLT STEM MOLD HIP W/REINF 9X125
|
Facility
|
IP
|
$4,945.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002937
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,978.00 |
| Max. Negotiated Rate |
$4,697.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,956.00
|
| Rate for Payer: Cash Price |
$2,967.00
|
| Rate for Payer: Cash Price |
$2,967.00
|
| Rate for Payer: Cigna Commercial |
$4,203.25
|
| Rate for Payer: First Health Commercial |
$4,450.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,450.50
|
| Rate for Payer: GEHA Commercial |
$3,461.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,450.50
|
| Rate for Payer: Multiplan All |
$4,499.95
|
| Rate for Payer: OMNI Networks Commercial |
$3,461.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4,450.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,697.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3,708.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,598.85
|
| Rate for Payer: Zelis Auto |
$1,978.00
|
|
|
IMPLT STEM OFFSET SIZE 6
|
Facility
|
IP
|
$4,598.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002309
|
|
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 OFFSET SIZE 6
|
Facility
|
OP
|
$4,598.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002309
|
|
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 PHOTO CONTROL 120/277VAC
|
Facility
|
OP
|
$295.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002310
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$73.75 |
| Max. Negotiated Rate |
$280.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$177.00
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$250.75
|
| Rate for Payer: First Health Commercial |
$265.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$265.50
|
| Rate for Payer: GEHA Commercial |
$236.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$265.50
|
| Rate for Payer: Humana ChoiceCare |
$76.70
|
| Rate for Payer: Multiplan All |
$268.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$177.00
|
| Rate for Payer: OMNI Networks Commercial |
$206.50
|
| Rate for Payer: One Health Plan PPO/POS |
$265.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$280.25
|
| Rate for Payer: Three Rivers Provider Network All |
$221.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$259.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$73.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$274.35
|
| Rate for Payer: Zelis Auto |
$118.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$147.50
|
|
|
IMPLT STEM PHOTO CONTROL 120/277VAC
|
Facility
|
IP
|
$295.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002310
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$118.00 |
| Max. Negotiated Rate |
$280.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$236.00
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$250.75
|
| Rate for Payer: First Health Commercial |
$265.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$265.50
|
| Rate for Payer: GEHA Commercial |
$206.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$265.50
|
| Rate for Payer: Multiplan All |
$268.45
|
| Rate for Payer: OMNI Networks Commercial |
$206.50
|
| Rate for Payer: One Health Plan PPO/POS |
$265.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$280.25
|
| Rate for Payer: Three Rivers Provider Network All |
$221.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$274.35
|
| Rate for Payer: Zelis Auto |
$118.00
|
|
|
IMPLT STEM REPLACEMENT CEMENTED STRAIGHT
|
Facility
|
OP
|
$7,835.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002685
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,958.75 |
| Max. Negotiated Rate |
$7,443.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,701.00
|
| Rate for Payer: Cash Price |
$4,701.00
|
| Rate for Payer: Cash Price |
$4,701.00
|
| Rate for Payer: Cigna Commercial |
$6,659.75
|
| Rate for Payer: First Health Commercial |
$7,051.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,051.50
|
| Rate for Payer: GEHA Commercial |
$6,268.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,051.50
|
| Rate for Payer: Humana ChoiceCare |
$2,037.10
|
| Rate for Payer: Multiplan All |
$7,129.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,701.00
|
| Rate for Payer: OMNI Networks Commercial |
$5,484.50
|
| Rate for Payer: One Health Plan PPO/POS |
$7,051.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,443.25
|
| Rate for Payer: Three Rivers Provider Network All |
$5,876.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,894.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,958.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,286.55
|
| Rate for Payer: Zelis Auto |
$3,134.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,917.50
|
|
|
IMPLT STEM REPLACEMENT CEMENTED STRAIGHT
|
Facility
|
IP
|
$7,835.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002685
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,134.00 |
| Max. Negotiated Rate |
$7,443.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,268.00
|
| Rate for Payer: Cash Price |
$4,701.00
|
| Rate for Payer: Cash Price |
$4,701.00
|
| Rate for Payer: Cigna Commercial |
$6,659.75
|
| Rate for Payer: First Health Commercial |
$7,051.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,051.50
|
| Rate for Payer: GEHA Commercial |
$5,484.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,051.50
|
| Rate for Payer: Multiplan All |
$7,129.85
|
| Rate for Payer: OMNI Networks Commercial |
$5,484.50
|
| Rate for Payer: One Health Plan PPO/POS |
$7,051.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,443.25
|
| Rate for Payer: Three Rivers Provider Network All |
$5,876.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,286.55
|
| Rate for Payer: Zelis Auto |
$3,134.00
|
|
|
IMPLT STEM REVISION COMPREHENSIVE 8X194
|
Facility
|
OP
|
$20,743.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002159
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,185.75 |
| Max. Negotiated Rate |
$19,705.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$12,445.80
|
| Rate for Payer: Cash Price |
$12,445.80
|
| Rate for Payer: Cash Price |
$12,445.80
|
| Rate for Payer: Cigna Commercial |
$17,631.55
|
| Rate for Payer: First Health Commercial |
$18,668.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$18,668.70
|
| Rate for Payer: GEHA Commercial |
$16,594.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$18,668.70
|
| Rate for Payer: Humana ChoiceCare |
$5,393.18
|
| Rate for Payer: Multiplan All |
$18,876.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$12,445.80
|
| Rate for Payer: OMNI Networks Commercial |
$14,520.10
|
| Rate for Payer: One Health Plan PPO/POS |
$18,668.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$19,705.85
|
| Rate for Payer: Three Rivers Provider Network All |
$15,557.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$18,253.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,185.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$19,290.99
|
| Rate for Payer: Zelis Auto |
$8,297.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10,371.50
|
|
|
IMPLT STEM REVISION COMPREHENSIVE 8X194
|
Facility
|
IP
|
$20,743.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002159
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,297.20 |
| Max. Negotiated Rate |
$19,705.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$16,594.40
|
| Rate for Payer: Cash Price |
$12,445.80
|
| Rate for Payer: Cash Price |
$12,445.80
|
| Rate for Payer: Cigna Commercial |
$17,631.55
|
| Rate for Payer: First Health Commercial |
$18,668.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$18,668.70
|
| Rate for Payer: GEHA Commercial |
$14,520.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$18,668.70
|
| Rate for Payer: Multiplan All |
$18,876.13
|
| Rate for Payer: OMNI Networks Commercial |
$14,520.10
|
| Rate for Payer: One Health Plan PPO/POS |
$18,668.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$19,705.85
|
| Rate for Payer: Three Rivers Provider Network All |
$15,557.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$19,290.99
|
| Rate for Payer: Zelis Auto |
$8,297.20
|
|
|
IMPLT STEM SHOULDER MICRO 9X55MM
|
Facility
|
OP
|
$17,283.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002311
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,320.75 |
| Max. Negotiated Rate |
$16,418.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$10,369.80
|
| Rate for Payer: Cash Price |
$10,369.80
|
| Rate for Payer: Cash Price |
$10,369.80
|
| Rate for Payer: Cigna Commercial |
$14,690.55
|
| Rate for Payer: First Health Commercial |
$15,554.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$15,554.70
|
| Rate for Payer: GEHA Commercial |
$13,826.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$15,554.70
|
| Rate for Payer: Humana ChoiceCare |
$4,493.58
|
| Rate for Payer: Multiplan All |
$15,727.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10,369.80
|
| Rate for Payer: OMNI Networks Commercial |
$12,098.10
|
| Rate for Payer: One Health Plan PPO/POS |
$15,554.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$16,418.85
|
| Rate for Payer: Three Rivers Provider Network All |
$12,962.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$15,209.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,320.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$16,073.19
|
| Rate for Payer: Zelis Auto |
$6,913.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,641.50
|
|
