|
IMPLT STEM SHOULDER MICRO 9X55MM
|
Facility
|
IP
|
$17,283.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002311
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,913.20 |
| Max. Negotiated Rate |
$16,418.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$13,826.40
|
| 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 |
$12,098.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$15,554.70
|
| Rate for Payer: Multiplan All |
$15,727.53
|
| 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: United Payors & United Providers UP&UP |
$16,073.19
|
| Rate for Payer: Zelis Auto |
$6,913.20
|
|
|
IMPLT STEM SHOULDER PRIMARY 13X83
|
Facility
|
OP
|
$16,531.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002168
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,132.75 |
| Max. Negotiated Rate |
$15,704.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9,918.60
|
| Rate for Payer: Cash Price |
$9,918.60
|
| Rate for Payer: Cash Price |
$9,918.60
|
| Rate for Payer: Cigna Commercial |
$14,051.35
|
| Rate for Payer: First Health Commercial |
$14,877.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$14,877.90
|
| Rate for Payer: GEHA Commercial |
$13,224.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$14,877.90
|
| Rate for Payer: Humana ChoiceCare |
$4,298.06
|
| Rate for Payer: Multiplan All |
$15,043.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,918.60
|
| Rate for Payer: OMNI Networks Commercial |
$11,571.70
|
| Rate for Payer: One Health Plan PPO/POS |
$14,877.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$15,704.45
|
| Rate for Payer: Three Rivers Provider Network All |
$12,398.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14,547.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,132.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$15,373.83
|
| Rate for Payer: Zelis Auto |
$6,612.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,265.50
|
|
|
IMPLT STEM SHOULDER PRIMARY 13X83
|
Facility
|
IP
|
$16,531.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002168
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,612.40 |
| Max. Negotiated Rate |
$15,704.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$13,224.80
|
| Rate for Payer: Cash Price |
$9,918.60
|
| Rate for Payer: Cash Price |
$9,918.60
|
| Rate for Payer: Cigna Commercial |
$14,051.35
|
| Rate for Payer: First Health Commercial |
$14,877.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$14,877.90
|
| Rate for Payer: GEHA Commercial |
$11,571.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$14,877.90
|
| Rate for Payer: Multiplan All |
$15,043.21
|
| Rate for Payer: OMNI Networks Commercial |
$11,571.70
|
| Rate for Payer: One Health Plan PPO/POS |
$14,877.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$15,704.45
|
| Rate for Payer: Three Rivers Provider Network All |
$12,398.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$15,373.83
|
| Rate for Payer: Zelis Auto |
$6,612.40
|
|
|
IMPLT STEM SPLINED 14X120MM
|
Facility
|
IP
|
$5,581.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002312
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,232.40 |
| Max. Negotiated Rate |
$5,301.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,464.80
|
| Rate for Payer: Cash Price |
$3,348.60
|
| Rate for Payer: Cash Price |
$3,348.60
|
| Rate for Payer: Cigna Commercial |
$4,743.85
|
| Rate for Payer: First Health Commercial |
$5,022.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,022.90
|
| Rate for Payer: GEHA Commercial |
$3,906.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,022.90
|
| Rate for Payer: Multiplan All |
$5,078.71
|
| Rate for Payer: OMNI Networks Commercial |
$3,906.70
|
| Rate for Payer: One Health Plan PPO/POS |
$5,022.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,301.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,185.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,190.33
|
| Rate for Payer: Zelis Auto |
$2,232.40
|
|
|
IMPLT STEM SPLINED 14X120MM
|
Facility
|
OP
|
$5,581.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002312
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,395.25 |
| Max. Negotiated Rate |
$5,301.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,348.60
|
| Rate for Payer: Cash Price |
$3,348.60
|
| Rate for Payer: Cash Price |
$3,348.60
|
| Rate for Payer: Cigna Commercial |
$4,743.85
|
| Rate for Payer: First Health Commercial |
$5,022.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,022.90
|
| Rate for Payer: GEHA Commercial |
$4,464.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,022.90
|
| Rate for Payer: Humana ChoiceCare |
$1,451.06
|
| Rate for Payer: Multiplan All |
$5,078.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,348.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,906.70
|
| Rate for Payer: One Health Plan PPO/POS |
$5,022.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,301.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,185.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,911.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,395.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,190.33
|
| Rate for Payer: Zelis Auto |
$2,232.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,790.50
|
|
|
IMPLT STEM SPLINED 14X80MM
|
Facility
|
IP
|
$5,581.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002289
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,232.40 |
| Max. Negotiated Rate |
$5,301.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,464.80
|
| Rate for Payer: Cash Price |
$3,348.60
|
| Rate for Payer: Cash Price |
$3,348.60
|
| Rate for Payer: Cigna Commercial |
$4,743.85
|
| Rate for Payer: First Health Commercial |
$5,022.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,022.90
|
| Rate for Payer: GEHA Commercial |
$3,906.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,022.90
|
| Rate for Payer: Multiplan All |
$5,078.71
|
| Rate for Payer: OMNI Networks Commercial |
$3,906.70
|
| Rate for Payer: One Health Plan PPO/POS |
$5,022.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,301.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,185.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,190.33
|
| Rate for Payer: Zelis Auto |
$2,232.40
|
|
|
IMPLT STEM SPLINED 14X80MM
|
Facility
|
OP
|
$5,581.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002289
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,395.25 |
| Max. Negotiated Rate |
$5,301.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,348.60
|
| Rate for Payer: Cash Price |
$3,348.60
|
| Rate for Payer: Cash Price |
$3,348.60
|
| Rate for Payer: Cigna Commercial |
$4,743.85
|
| Rate for Payer: First Health Commercial |
$5,022.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,022.90
|
| Rate for Payer: GEHA Commercial |
$4,464.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,022.90
|
| Rate for Payer: Humana ChoiceCare |
$1,451.06
|
| Rate for Payer: Multiplan All |
$5,078.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,348.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,906.70
|
| Rate for Payer: One Health Plan PPO/POS |
$5,022.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,301.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,185.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,911.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,395.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,190.33
|
| Rate for Payer: Zelis Auto |
$2,232.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,790.50
|
|
|
IMPLT STEM TAPERLOC MICRO 9X102.5
|
Facility
|
OP
|
$18,812.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002313
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,703.00 |
| Max. Negotiated Rate |
$17,871.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$11,287.20
|
| Rate for Payer: Cash Price |
$11,287.20
|
| Rate for Payer: Cash Price |
$11,287.20
|
| Rate for Payer: Cigna Commercial |
$15,990.20
|
| Rate for Payer: First Health Commercial |
$16,930.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$16,930.80
|
| Rate for Payer: GEHA Commercial |
$15,049.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$16,930.80
|
| Rate for Payer: Humana ChoiceCare |
$4,891.12
|
| Rate for Payer: Multiplan All |
$17,118.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,287.20
|
| Rate for Payer: OMNI Networks Commercial |
$13,168.40
|
| Rate for Payer: One Health Plan PPO/POS |
$16,930.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$17,871.40
|
| Rate for Payer: Three Rivers Provider Network All |
$14,109.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16,554.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,703.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$17,495.16
|
| Rate for Payer: Zelis Auto |
$7,524.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9,406.00
|
|
|
IMPLT STEM TAPERLOC MICRO 9X102.5
|
Facility
|
IP
|
$18,812.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002313
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,524.80 |
| Max. Negotiated Rate |
$17,871.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$15,049.60
|
| Rate for Payer: Cash Price |
$11,287.20
|
| Rate for Payer: Cash Price |
$11,287.20
|
| Rate for Payer: Cigna Commercial |
$15,990.20
|
| Rate for Payer: First Health Commercial |
$16,930.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$16,930.80
|
| Rate for Payer: GEHA Commercial |
$13,168.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$16,930.80
|
| Rate for Payer: Multiplan All |
$17,118.92
|
| Rate for Payer: OMNI Networks Commercial |
$13,168.40
|
| Rate for Payer: One Health Plan PPO/POS |
$16,930.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$17,871.40
|
| Rate for Payer: Three Rivers Provider Network All |
$14,109.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$17,495.16
|
| Rate for Payer: Zelis Auto |
$7,524.80
|
|
|
IMPLT STEM TAPERLOC XR123 4X93
|
Facility
|
OP
|
$20,091.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002169
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,022.75 |
| Max. Negotiated Rate |
$19,086.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$12,054.60
|
| Rate for Payer: Cash Price |
$12,054.60
|
| Rate for Payer: Cash Price |
$12,054.60
|
| Rate for Payer: Cigna Commercial |
$17,077.35
|
| Rate for Payer: First Health Commercial |
$18,081.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$18,081.90
|
| Rate for Payer: GEHA Commercial |
$16,072.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$18,081.90
|
| Rate for Payer: Humana ChoiceCare |
$5,223.66
|
| Rate for Payer: Multiplan All |
$18,282.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$12,054.60
|
| Rate for Payer: OMNI Networks Commercial |
$14,063.70
|
| Rate for Payer: One Health Plan PPO/POS |
$18,081.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$19,086.45
|
| Rate for Payer: Three Rivers Provider Network All |
$15,068.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17,680.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,022.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$18,684.63
|
| Rate for Payer: Zelis Auto |
$8,036.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10,045.50
|
|
|
IMPLT STEM TAPERLOC XR123 4X93
|
Facility
|
IP
|
$20,091.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002169
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,036.40 |
| Max. Negotiated Rate |
$19,086.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$16,072.80
|
| Rate for Payer: Cash Price |
$12,054.60
|
| Rate for Payer: Cash Price |
$12,054.60
|
| Rate for Payer: Cigna Commercial |
$17,077.35
|
| Rate for Payer: First Health Commercial |
$18,081.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$18,081.90
|
| Rate for Payer: GEHA Commercial |
$14,063.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$18,081.90
|
| Rate for Payer: Multiplan All |
$18,282.81
|
| Rate for Payer: OMNI Networks Commercial |
$14,063.70
|
| Rate for Payer: One Health Plan PPO/POS |
$18,081.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$19,086.45
|
| Rate for Payer: Three Rivers Provider Network All |
$15,068.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$18,684.63
|
| Rate for Payer: Zelis Auto |
$8,036.40
|
|
|
IMPLT STEM TAPERLOC XR123 8X101MM
|
Facility
|
IP
|
$20,091.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002170
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,036.40 |
| Max. Negotiated Rate |
$19,086.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$16,072.80
|
| Rate for Payer: Cash Price |
$12,054.60
|
| Rate for Payer: Cash Price |
$12,054.60
|
| Rate for Payer: Cigna Commercial |
$17,077.35
|
| Rate for Payer: First Health Commercial |
$18,081.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$18,081.90
|
| Rate for Payer: GEHA Commercial |
$14,063.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$18,081.90
|
| Rate for Payer: Multiplan All |
$18,282.81
|
| Rate for Payer: OMNI Networks Commercial |
$14,063.70
|
| Rate for Payer: One Health Plan PPO/POS |
$18,081.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$19,086.45
|
| Rate for Payer: Three Rivers Provider Network All |
$15,068.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$18,684.63
|
| Rate for Payer: Zelis Auto |
$8,036.40
|
|
|
IMPLT STEM TAPERLOC XR123 8X101MM
|
Facility
|
OP
|
$20,091.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002170
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,022.75 |
| Max. Negotiated Rate |
$19,086.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$12,054.60
|
| Rate for Payer: Cash Price |
$12,054.60
|
| Rate for Payer: Cash Price |
$12,054.60
|
| Rate for Payer: Cigna Commercial |
$17,077.35
|
| Rate for Payer: First Health Commercial |
$18,081.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$18,081.90
|
| Rate for Payer: GEHA Commercial |
$16,072.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$18,081.90
|
| Rate for Payer: Humana ChoiceCare |
$5,223.66
|
| Rate for Payer: Multiplan All |
$18,282.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$12,054.60
|
| Rate for Payer: OMNI Networks Commercial |
$14,063.70
|
| Rate for Payer: One Health Plan PPO/POS |
$18,081.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$19,086.45
|
| Rate for Payer: Three Rivers Provider Network All |
$15,068.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17,680.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,022.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$18,684.63
|
| Rate for Payer: Zelis Auto |
$8,036.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10,045.50
|
|
|
IMPLT STEM TRIAL CEMENTED 12X50MM
|
Facility
|
IP
|
$1,253.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002892
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$501.20 |
| Max. Negotiated Rate |
$1,190.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,002.40
|
| Rate for Payer: Cash Price |
$751.80
|
| Rate for Payer: Cash Price |
$751.80
|
| Rate for Payer: Cigna Commercial |
$1,065.05
|
| Rate for Payer: First Health Commercial |
$1,127.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,127.70
|
| Rate for Payer: GEHA Commercial |
$877.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,127.70
|
| Rate for Payer: Multiplan All |
$1,140.23
|
| Rate for Payer: OMNI Networks Commercial |
$877.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,127.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,190.35
|
| Rate for Payer: Three Rivers Provider Network All |
$939.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,165.29
|
| Rate for Payer: Zelis Auto |
$501.20
|
|
|
IMPLT STEM TRIAL CEMENTED 12X50MM
|
Facility
|
OP
|
$1,253.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002892
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$313.25 |
| Max. Negotiated Rate |
$1,190.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$751.80
|
| Rate for Payer: Cash Price |
$751.80
|
| Rate for Payer: Cash Price |
$751.80
|
| Rate for Payer: Cigna Commercial |
$1,065.05
|
| Rate for Payer: First Health Commercial |
$1,127.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,127.70
|
| Rate for Payer: GEHA Commercial |
$1,002.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,127.70
|
| Rate for Payer: Humana ChoiceCare |
$325.78
|
| Rate for Payer: Multiplan All |
$1,140.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$751.80
|
| Rate for Payer: OMNI Networks Commercial |
$877.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,127.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,190.35
|
| Rate for Payer: Three Rivers Provider Network All |
$939.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,102.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$313.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,165.29
|
| Rate for Payer: Zelis Auto |
$501.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$626.50
|
|
|
IMPLT STEM TRIATHLON CEMENTED 12X150MM
|
Facility
|
IP
|
$3,607.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002160
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,442.80 |
| Max. Negotiated Rate |
$3,426.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,885.60
|
| Rate for Payer: Cash Price |
$2,164.20
|
| Rate for Payer: Cash Price |
$2,164.20
|
| Rate for Payer: Cigna Commercial |
$3,065.95
|
| Rate for Payer: First Health Commercial |
$3,246.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,246.30
|
| Rate for Payer: GEHA Commercial |
$2,524.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,246.30
|
| Rate for Payer: Multiplan All |
$3,282.37
|
| Rate for Payer: OMNI Networks Commercial |
$2,524.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,246.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,426.65
|
| Rate for Payer: Three Rivers Provider Network All |
$2,705.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,354.51
|
| Rate for Payer: Zelis Auto |
$1,442.80
|
|
|
IMPLT STEM TRIATHLON CEMENTED 12X150MM
|
Facility
|
OP
|
$3,607.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002160
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$901.75 |
| Max. Negotiated Rate |
$3,426.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,164.20
|
| Rate for Payer: Cash Price |
$2,164.20
|
| Rate for Payer: Cash Price |
$2,164.20
|
| Rate for Payer: Cigna Commercial |
$3,065.95
|
| Rate for Payer: First Health Commercial |
$3,246.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,246.30
|
| Rate for Payer: GEHA Commercial |
$2,885.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,246.30
|
| Rate for Payer: Humana ChoiceCare |
$937.82
|
| Rate for Payer: Multiplan All |
$3,282.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,164.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,524.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,246.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,426.65
|
| Rate for Payer: Three Rivers Provider Network All |
$2,705.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,174.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$901.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,354.51
|
| Rate for Payer: Zelis Auto |
$1,442.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,803.50
|
|
|
IMPLT STEM WAGNER SL 17X225MM
|
Facility
|
OP
|
$18,914.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002314
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,728.50 |
| Max. Negotiated Rate |
$17,968.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$11,348.40
|
| Rate for Payer: Cash Price |
$11,348.40
|
| Rate for Payer: Cash Price |
$11,348.40
|
| Rate for Payer: Cigna Commercial |
$16,076.90
|
| Rate for Payer: First Health Commercial |
$17,022.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$17,022.60
|
| Rate for Payer: GEHA Commercial |
$15,131.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$17,022.60
|
| Rate for Payer: Humana ChoiceCare |
$4,917.64
|
| Rate for Payer: Multiplan All |
$17,211.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,348.40
|
| Rate for Payer: OMNI Networks Commercial |
$13,239.80
|
| Rate for Payer: One Health Plan PPO/POS |
$17,022.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$17,968.30
|
| Rate for Payer: Three Rivers Provider Network All |
$14,185.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16,644.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,728.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$17,590.02
|
| Rate for Payer: Zelis Auto |
$7,565.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9,457.00
|
|
|
IMPLT STEM WAGNER SL 17X225MM
|
Facility
|
IP
|
$18,914.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002314
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,565.60 |
| Max. Negotiated Rate |
$17,968.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$15,131.20
|
| Rate for Payer: Cash Price |
$11,348.40
|
| Rate for Payer: Cash Price |
$11,348.40
|
| Rate for Payer: Cigna Commercial |
$16,076.90
|
| Rate for Payer: First Health Commercial |
$17,022.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$17,022.60
|
| Rate for Payer: GEHA Commercial |
$13,239.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$17,022.60
|
| Rate for Payer: Multiplan All |
$17,211.74
|
| Rate for Payer: OMNI Networks Commercial |
$13,239.80
|
| Rate for Payer: One Health Plan PPO/POS |
$17,022.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$17,968.30
|
| Rate for Payer: Three Rivers Provider Network All |
$14,185.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$17,590.02
|
| Rate for Payer: Zelis Auto |
$7,565.60
|
|
|
IMPLT STENT 4.7 X 20CM
|
Facility
|
IP
|
$1,289.92
|
|
|
Service Code
|
CPT C1758
|
| Hospital Charge Code |
7004286
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$515.97 |
| Max. Negotiated Rate |
$1,225.42 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,031.94
|
| Rate for Payer: Cash Price |
$773.95
|
| Rate for Payer: Cash Price |
$773.95
|
| Rate for Payer: Cigna Commercial |
$1,096.43
|
| Rate for Payer: First Health Commercial |
$1,160.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,160.93
|
| Rate for Payer: GEHA Commercial |
$902.94
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,160.93
|
| Rate for Payer: Multiplan All |
$1,173.83
|
| Rate for Payer: OMNI Networks Commercial |
$902.94
|
| Rate for Payer: One Health Plan PPO/POS |
$1,160.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,225.42
|
| Rate for Payer: Three Rivers Provider Network All |
$967.44
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,199.63
|
| Rate for Payer: Zelis Auto |
$515.97
|
|
|
IMPLT STENT 4.7 X 20CM
|
Facility
|
OP
|
$1,289.92
|
|
|
Service Code
|
CPT C1758
|
| Hospital Charge Code |
7004286
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$322.48 |
| Max. Negotiated Rate |
$1,225.42 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$773.95
|
| Rate for Payer: Cash Price |
$773.95
|
| Rate for Payer: Cash Price |
$773.95
|
| Rate for Payer: Cigna Commercial |
$1,096.43
|
| Rate for Payer: First Health Commercial |
$1,160.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,160.93
|
| Rate for Payer: GEHA Commercial |
$1,031.94
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,160.93
|
| Rate for Payer: Humana ChoiceCare |
$335.38
|
| Rate for Payer: Multiplan All |
$1,173.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$773.95
|
| Rate for Payer: OMNI Networks Commercial |
$902.94
|
| Rate for Payer: One Health Plan PPO/POS |
$1,160.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,225.42
|
| Rate for Payer: Three Rivers Provider Network All |
$967.44
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,135.13
|
| Rate for Payer: United Healthcare Managed Medicaid |
$322.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,199.63
|
| Rate for Payer: Zelis Auto |
$515.97
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$644.96
|
|
|
IMPLT STENT 4.7 X 22CM
|
Facility
|
IP
|
$1,289.92
|
|
|
Service Code
|
CPT C1758
|
| Hospital Charge Code |
7004287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$515.97 |
| Max. Negotiated Rate |
$1,225.42 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,031.94
|
| Rate for Payer: Cash Price |
$773.95
|
| Rate for Payer: Cash Price |
$773.95
|
| Rate for Payer: Cigna Commercial |
$1,096.43
|
| Rate for Payer: First Health Commercial |
$1,160.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,160.93
|
| Rate for Payer: GEHA Commercial |
$902.94
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,160.93
|
| Rate for Payer: Multiplan All |
$1,173.83
|
| Rate for Payer: OMNI Networks Commercial |
$902.94
|
| Rate for Payer: One Health Plan PPO/POS |
$1,160.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,225.42
|
| Rate for Payer: Three Rivers Provider Network All |
$967.44
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,199.63
|
| Rate for Payer: Zelis Auto |
$515.97
|
|
|
IMPLT STENT 4.7 X 22CM
|
Facility
|
OP
|
$1,289.92
|
|
|
Service Code
|
CPT C1758
|
| Hospital Charge Code |
7004287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$322.48 |
| Max. Negotiated Rate |
$1,225.42 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$773.95
|
| Rate for Payer: Cash Price |
$773.95
|
| Rate for Payer: Cash Price |
$773.95
|
| Rate for Payer: Cigna Commercial |
$1,096.43
|
| Rate for Payer: First Health Commercial |
$1,160.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,160.93
|
| Rate for Payer: GEHA Commercial |
$1,031.94
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,160.93
|
| Rate for Payer: Humana ChoiceCare |
$335.38
|
| Rate for Payer: Multiplan All |
$1,173.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$773.95
|
| Rate for Payer: OMNI Networks Commercial |
$902.94
|
| Rate for Payer: One Health Plan PPO/POS |
$1,160.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,225.42
|
| Rate for Payer: Three Rivers Provider Network All |
$967.44
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,135.13
|
| Rate for Payer: United Healthcare Managed Medicaid |
$322.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,199.63
|
| Rate for Payer: Zelis Auto |
$515.97
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$644.96
|
|
|
IMPLT STENT 4.7 X 24CM
|
Facility
|
OP
|
$1,289.92
|
|
|
Service Code
|
CPT C1758
|
| Hospital Charge Code |
7004291
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$322.48 |
| Max. Negotiated Rate |
$1,225.42 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$773.95
|
| Rate for Payer: Cash Price |
$773.95
|
| Rate for Payer: Cash Price |
$773.95
|
| Rate for Payer: Cigna Commercial |
$1,096.43
|
| Rate for Payer: First Health Commercial |
$1,160.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,160.93
|
| Rate for Payer: GEHA Commercial |
$1,031.94
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,160.93
|
| Rate for Payer: Humana ChoiceCare |
$335.38
|
| Rate for Payer: Multiplan All |
$1,173.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$773.95
|
| Rate for Payer: OMNI Networks Commercial |
$902.94
|
| Rate for Payer: One Health Plan PPO/POS |
$1,160.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,225.42
|
| Rate for Payer: Three Rivers Provider Network All |
$967.44
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,135.13
|
| Rate for Payer: United Healthcare Managed Medicaid |
$322.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,199.63
|
| Rate for Payer: Zelis Auto |
$515.97
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$644.96
|
|
|
IMPLT STENT 4.7 X 24CM
|
Facility
|
OP
|
$1,289.92
|
|
|
Service Code
|
CPT C1758
|
| Hospital Charge Code |
7004288
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$322.48 |
| Max. Negotiated Rate |
$1,225.42 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$773.95
|
| Rate for Payer: Cash Price |
$773.95
|
| Rate for Payer: Cash Price |
$773.95
|
| Rate for Payer: Cigna Commercial |
$1,096.43
|
| Rate for Payer: First Health Commercial |
$1,160.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,160.93
|
| Rate for Payer: GEHA Commercial |
$1,031.94
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,160.93
|
| Rate for Payer: Humana ChoiceCare |
$335.38
|
| Rate for Payer: Multiplan All |
$1,173.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$773.95
|
| Rate for Payer: OMNI Networks Commercial |
$902.94
|
| Rate for Payer: One Health Plan PPO/POS |
$1,160.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,225.42
|
| Rate for Payer: Three Rivers Provider Network All |
$967.44
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,135.13
|
| Rate for Payer: United Healthcare Managed Medicaid |
$322.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,199.63
|
| Rate for Payer: Zelis Auto |
$515.97
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$644.96
|
|
