|
IMPLT TIBIAL INSERT
|
Facility
|
OP
|
$3,499.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003400
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$874.75 |
| Max. Negotiated Rate |
$3,324.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,099.40
|
| Rate for Payer: Cash Price |
$2,099.40
|
| Rate for Payer: Cash Price |
$2,099.40
|
| Rate for Payer: Cigna Commercial |
$2,974.15
|
| Rate for Payer: First Health Commercial |
$3,149.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,149.10
|
| Rate for Payer: GEHA Commercial |
$2,799.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,149.10
|
| Rate for Payer: Humana ChoiceCare |
$909.74
|
| Rate for Payer: Multiplan All |
$3,184.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,099.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,449.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,149.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,324.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,624.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,079.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$874.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,254.07
|
| Rate for Payer: Zelis Auto |
$1,399.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,749.50
|
|
|
IMPLT TIBIAL INSERT
|
Facility
|
IP
|
$3,499.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003400
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,399.60 |
| Max. Negotiated Rate |
$3,324.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,799.20
|
| Rate for Payer: Cash Price |
$2,099.40
|
| Rate for Payer: Cash Price |
$2,099.40
|
| Rate for Payer: Cigna Commercial |
$2,974.15
|
| Rate for Payer: First Health Commercial |
$3,149.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,149.10
|
| Rate for Payer: GEHA Commercial |
$2,449.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,149.10
|
| Rate for Payer: Multiplan All |
$3,184.09
|
| Rate for Payer: OMNI Networks Commercial |
$2,449.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,149.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,324.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,624.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,254.07
|
| Rate for Payer: Zelis Auto |
$1,399.60
|
|
|
IMPLT TIBIAL INSERT 11MM
|
Facility
|
OP
|
$6,849.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002177
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,712.25 |
| Max. Negotiated Rate |
$6,506.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,109.40
|
| Rate for Payer: Cash Price |
$4,109.40
|
| Rate for Payer: Cash Price |
$4,109.40
|
| Rate for Payer: Cigna Commercial |
$5,821.65
|
| Rate for Payer: First Health Commercial |
$6,164.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,164.10
|
| Rate for Payer: GEHA Commercial |
$5,479.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,164.10
|
| Rate for Payer: Humana ChoiceCare |
$1,780.74
|
| Rate for Payer: Multiplan All |
$6,232.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,109.40
|
| Rate for Payer: OMNI Networks Commercial |
$4,794.30
|
| Rate for Payer: One Health Plan PPO/POS |
$6,164.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,506.55
|
| Rate for Payer: Three Rivers Provider Network All |
$5,136.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,027.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,712.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,369.57
|
| Rate for Payer: Zelis Auto |
$2,739.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,424.50
|
|
|
IMPLT TIBIAL INSERT 11MM
|
Facility
|
IP
|
$6,849.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002177
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,739.60 |
| Max. Negotiated Rate |
$6,506.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,479.20
|
| Rate for Payer: Cash Price |
$4,109.40
|
| Rate for Payer: Cash Price |
$4,109.40
|
| Rate for Payer: Cigna Commercial |
$5,821.65
|
| Rate for Payer: First Health Commercial |
$6,164.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,164.10
|
| Rate for Payer: GEHA Commercial |
$4,794.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,164.10
|
| Rate for Payer: Multiplan All |
$6,232.59
|
| Rate for Payer: OMNI Networks Commercial |
$4,794.30
|
| Rate for Payer: One Health Plan PPO/POS |
$6,164.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,506.55
|
| Rate for Payer: Three Rivers Provider Network All |
$5,136.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,369.57
|
| Rate for Payer: Zelis Auto |
$2,739.60
|
|
|
IMPLT TIBIAL INSERT 9MM #4
|
Facility
|
IP
|
$6,849.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002800
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,739.60 |
| Max. Negotiated Rate |
$6,506.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,479.20
|
| Rate for Payer: Cash Price |
$4,109.40
|
| Rate for Payer: Cash Price |
$4,109.40
|
| Rate for Payer: Cigna Commercial |
$5,821.65
|
| Rate for Payer: First Health Commercial |
$6,164.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,164.10
|
| Rate for Payer: GEHA Commercial |
$4,794.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,164.10
|
| Rate for Payer: Multiplan All |
$6,232.59
|
| Rate for Payer: OMNI Networks Commercial |
$4,794.30
|
| Rate for Payer: One Health Plan PPO/POS |
$6,164.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,506.55
|
| Rate for Payer: Three Rivers Provider Network All |
$5,136.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,369.57
|
| Rate for Payer: Zelis Auto |
$2,739.60
|
|
|
IMPLT TIBIAL INSERT 9MM #4
|
Facility
|
OP
|
$6,849.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002800
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,712.25 |
| Max. Negotiated Rate |
$6,506.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,109.40
|
| Rate for Payer: Cash Price |
$4,109.40
|
| Rate for Payer: Cash Price |
$4,109.40
|
| Rate for Payer: Cigna Commercial |
$5,821.65
|
| Rate for Payer: First Health Commercial |
$6,164.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,164.10
|
| Rate for Payer: GEHA Commercial |
$5,479.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,164.10
|
| Rate for Payer: Humana ChoiceCare |
$1,780.74
|
| Rate for Payer: Multiplan All |
$6,232.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,109.40
|
| Rate for Payer: OMNI Networks Commercial |
$4,794.30
|
| Rate for Payer: One Health Plan PPO/POS |
$6,164.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,506.55
|
| Rate for Payer: Three Rivers Provider Network All |
$5,136.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,027.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,712.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,369.57
|
| Rate for Payer: Zelis Auto |
$2,739.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,424.50
|
|
|
IMPLT TIBIAL INSERT BEARING 5 CS 12MM
|
Facility
|
OP
|
$3,654.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006449
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$913.50 |
| Max. Negotiated Rate |
$3,471.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,192.40
|
| Rate for Payer: Cash Price |
$2,192.40
|
| Rate for Payer: Cash Price |
$2,192.40
|
| Rate for Payer: Cigna Commercial |
$3,105.90
|
| Rate for Payer: First Health Commercial |
$3,288.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,288.60
|
| Rate for Payer: GEHA Commercial |
$2,923.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,288.60
|
| Rate for Payer: Humana ChoiceCare |
$950.04
|
| Rate for Payer: Multiplan All |
$3,325.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,192.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,557.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,288.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,471.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,740.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,215.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$913.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,398.22
|
| Rate for Payer: Zelis Auto |
$1,461.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,827.00
|
|
|
IMPLT TIBIAL INSERT BEARING 5 CS 12MM
|
Facility
|
IP
|
$3,654.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006449
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,461.60 |
| Max. Negotiated Rate |
$3,471.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,923.20
|
| Rate for Payer: Cash Price |
$2,192.40
|
| Rate for Payer: Cash Price |
$2,192.40
|
| Rate for Payer: Cigna Commercial |
$3,105.90
|
| Rate for Payer: First Health Commercial |
$3,288.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,288.60
|
| Rate for Payer: GEHA Commercial |
$2,557.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,288.60
|
| Rate for Payer: Multiplan All |
$3,325.14
|
| Rate for Payer: OMNI Networks Commercial |
$2,557.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,288.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,471.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,740.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,398.22
|
| Rate for Payer: Zelis Auto |
$1,461.60
|
|
|
IMPLT TIBIAL INSERT ONLY
|
Facility
|
OP
|
$3,299.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$824.75 |
| Max. Negotiated Rate |
$3,134.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,979.40
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cigna Commercial |
$2,804.15
|
| Rate for Payer: First Health Commercial |
$2,969.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,969.10
|
| Rate for Payer: GEHA Commercial |
$2,639.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,969.10
|
| Rate for Payer: Humana ChoiceCare |
$857.74
|
| Rate for Payer: Multiplan All |
$3,002.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,979.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,309.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,969.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,134.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,474.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,903.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$824.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,068.07
|
| Rate for Payer: Zelis Auto |
$1,319.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,649.50
|
|
|
IMPLT TIBIAL INSERT ONLY
|
Facility
|
IP
|
$3,299.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,319.60 |
| Max. Negotiated Rate |
$3,134.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,639.20
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cigna Commercial |
$2,804.15
|
| Rate for Payer: First Health Commercial |
$2,969.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,969.10
|
| Rate for Payer: GEHA Commercial |
$2,309.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,969.10
|
| Rate for Payer: Multiplan All |
$3,002.09
|
| Rate for Payer: OMNI Networks Commercial |
$2,309.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,969.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,134.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,474.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,068.07
|
| Rate for Payer: Zelis Auto |
$1,319.60
|
|
|
IMPLT TIBIAL INSERT SZ 3 9MM
|
Facility
|
OP
|
$6,836.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003171
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,709.00 |
| Max. Negotiated Rate |
$6,494.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,101.60
|
| Rate for Payer: Cash Price |
$4,101.60
|
| Rate for Payer: Cash Price |
$4,101.60
|
| Rate for Payer: Cigna Commercial |
$5,810.60
|
| Rate for Payer: First Health Commercial |
$6,152.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,152.40
|
| Rate for Payer: GEHA Commercial |
$5,468.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,152.40
|
| Rate for Payer: Humana ChoiceCare |
$1,777.36
|
| Rate for Payer: Multiplan All |
$6,220.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,101.60
|
| Rate for Payer: OMNI Networks Commercial |
$4,785.20
|
| Rate for Payer: One Health Plan PPO/POS |
$6,152.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,494.20
|
| Rate for Payer: Three Rivers Provider Network All |
$5,127.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,015.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,709.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,357.48
|
| Rate for Payer: Zelis Auto |
$2,734.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,418.00
|
|
|
IMPLT TIBIAL INSERT SZ 3 9MM
|
Facility
|
IP
|
$6,836.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003171
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,734.40 |
| Max. Negotiated Rate |
$6,494.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,468.80
|
| Rate for Payer: Cash Price |
$4,101.60
|
| Rate for Payer: Cash Price |
$4,101.60
|
| Rate for Payer: Cigna Commercial |
$5,810.60
|
| Rate for Payer: First Health Commercial |
$6,152.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,152.40
|
| Rate for Payer: GEHA Commercial |
$4,785.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,152.40
|
| Rate for Payer: Multiplan All |
$6,220.76
|
| Rate for Payer: OMNI Networks Commercial |
$4,785.20
|
| Rate for Payer: One Health Plan PPO/POS |
$6,152.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,494.20
|
| Rate for Payer: Three Rivers Provider Network All |
$5,127.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,357.48
|
| Rate for Payer: Zelis Auto |
$2,734.40
|
|
|
IMPLT TIBIAL INSERT TS 13MM #3
|
Facility
|
IP
|
$6,836.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003138
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,734.40 |
| Max. Negotiated Rate |
$6,494.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,468.80
|
| Rate for Payer: Cash Price |
$4,101.60
|
| Rate for Payer: Cash Price |
$4,101.60
|
| Rate for Payer: Cigna Commercial |
$5,810.60
|
| Rate for Payer: First Health Commercial |
$6,152.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,152.40
|
| Rate for Payer: GEHA Commercial |
$4,785.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,152.40
|
| Rate for Payer: Multiplan All |
$6,220.76
|
| Rate for Payer: OMNI Networks Commercial |
$4,785.20
|
| Rate for Payer: One Health Plan PPO/POS |
$6,152.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,494.20
|
| Rate for Payer: Three Rivers Provider Network All |
$5,127.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,357.48
|
| Rate for Payer: Zelis Auto |
$2,734.40
|
|
|
IMPLT TIBIAL INSERT TS 13MM #3
|
Facility
|
OP
|
$6,836.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003138
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,709.00 |
| Max. Negotiated Rate |
$6,494.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,101.60
|
| Rate for Payer: Cash Price |
$4,101.60
|
| Rate for Payer: Cash Price |
$4,101.60
|
| Rate for Payer: Cigna Commercial |
$5,810.60
|
| Rate for Payer: First Health Commercial |
$6,152.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,152.40
|
| Rate for Payer: GEHA Commercial |
$5,468.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,152.40
|
| Rate for Payer: Humana ChoiceCare |
$1,777.36
|
| Rate for Payer: Multiplan All |
$6,220.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,101.60
|
| Rate for Payer: OMNI Networks Commercial |
$4,785.20
|
| Rate for Payer: One Health Plan PPO/POS |
$6,152.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,494.20
|
| Rate for Payer: Three Rivers Provider Network All |
$5,127.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,015.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,709.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,357.48
|
| Rate for Payer: Zelis Auto |
$2,734.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,418.00
|
|
|
IMPLT TIGHTROPE ABS 14MM BUTTON
|
Facility
|
IP
|
$1,474.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009231
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$589.60 |
| Max. Negotiated Rate |
$1,400.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,179.20
|
| Rate for Payer: Cash Price |
$884.40
|
| Rate for Payer: Cash Price |
$884.40
|
| Rate for Payer: Cigna Commercial |
$1,252.90
|
| Rate for Payer: First Health Commercial |
$1,326.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,326.60
|
| Rate for Payer: GEHA Commercial |
$1,031.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,326.60
|
| Rate for Payer: Multiplan All |
$1,341.34
|
| Rate for Payer: OMNI Networks Commercial |
$1,031.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,326.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,400.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,105.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,370.82
|
| Rate for Payer: Zelis Auto |
$589.60
|
|
|
IMPLT TIGHTROPE ABS 14MM BUTTON
|
Facility
|
OP
|
$1,474.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009231
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$368.50 |
| Max. Negotiated Rate |
$1,400.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$884.40
|
| Rate for Payer: Cash Price |
$884.40
|
| Rate for Payer: Cash Price |
$884.40
|
| Rate for Payer: Cigna Commercial |
$1,252.90
|
| Rate for Payer: First Health Commercial |
$1,326.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,326.60
|
| Rate for Payer: GEHA Commercial |
$1,179.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,326.60
|
| Rate for Payer: Humana ChoiceCare |
$383.24
|
| Rate for Payer: Multiplan All |
$1,341.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$884.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,031.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,326.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,400.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,105.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,297.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$368.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,370.82
|
| Rate for Payer: Zelis Auto |
$589.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$737.00
|
|
|
IMPLT TINED LEAD TRIAL KIT
|
Facility
|
IP
|
$13,489.00
|
|
|
Service Code
|
CPT C1897
|
| Hospital Charge Code |
7009049
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,395.60 |
| Max. Negotiated Rate |
$12,814.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$10,791.20
|
| Rate for Payer: Cash Price |
$8,093.40
|
| Rate for Payer: Cash Price |
$8,093.40
|
| Rate for Payer: Cigna Commercial |
$11,465.65
|
| Rate for Payer: First Health Commercial |
$12,140.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$12,140.10
|
| Rate for Payer: GEHA Commercial |
$9,442.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$12,140.10
|
| Rate for Payer: Multiplan All |
$12,274.99
|
| Rate for Payer: OMNI Networks Commercial |
$9,442.30
|
| Rate for Payer: One Health Plan PPO/POS |
$12,140.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$12,814.55
|
| Rate for Payer: Three Rivers Provider Network All |
$10,116.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$12,544.77
|
| Rate for Payer: Zelis Auto |
$5,395.60
|
|
|
IMPLT TINED LEAD TRIAL KIT
|
Facility
|
OP
|
$13,489.00
|
|
|
Service Code
|
CPT C1897
|
| Hospital Charge Code |
7009049
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,372.25 |
| Max. Negotiated Rate |
$12,814.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$8,093.40
|
| Rate for Payer: Cash Price |
$8,093.40
|
| Rate for Payer: Cash Price |
$8,093.40
|
| Rate for Payer: Cigna Commercial |
$11,465.65
|
| Rate for Payer: First Health Commercial |
$12,140.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$12,140.10
|
| Rate for Payer: GEHA Commercial |
$10,791.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$12,140.10
|
| Rate for Payer: Humana ChoiceCare |
$3,507.14
|
| Rate for Payer: Multiplan All |
$12,274.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,093.40
|
| Rate for Payer: OMNI Networks Commercial |
$9,442.30
|
| Rate for Payer: One Health Plan PPO/POS |
$12,140.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$12,814.55
|
| Rate for Payer: Three Rivers Provider Network All |
$10,116.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,870.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,372.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$12,544.77
|
| Rate for Payer: Zelis Auto |
$5,395.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,744.50
|
|
|
IMPLT TIP DISTAL CENTRALIZER 10MM
|
Facility
|
OP
|
$685.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002178
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$171.25 |
| Max. Negotiated Rate |
$650.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$411.00
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cigna Commercial |
$582.25
|
| Rate for Payer: First Health Commercial |
$616.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$616.50
|
| Rate for Payer: GEHA Commercial |
$548.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$616.50
|
| Rate for Payer: Humana ChoiceCare |
$178.10
|
| Rate for Payer: Multiplan All |
$623.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$411.00
|
| Rate for Payer: OMNI Networks Commercial |
$479.50
|
| Rate for Payer: One Health Plan PPO/POS |
$616.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$650.75
|
| Rate for Payer: Three Rivers Provider Network All |
$513.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$602.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$171.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$637.05
|
| Rate for Payer: Zelis Auto |
$274.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$342.50
|
|
|
IMPLT TIP DISTAL CENTRALIZER 10MM
|
Facility
|
IP
|
$685.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002178
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$274.00 |
| Max. Negotiated Rate |
$650.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$548.00
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cigna Commercial |
$582.25
|
| Rate for Payer: First Health Commercial |
$616.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$616.50
|
| Rate for Payer: GEHA Commercial |
$479.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$616.50
|
| Rate for Payer: Multiplan All |
$623.35
|
| Rate for Payer: OMNI Networks Commercial |
$479.50
|
| Rate for Payer: One Health Plan PPO/POS |
$616.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$650.75
|
| Rate for Payer: Three Rivers Provider Network All |
$513.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$637.05
|
| Rate for Payer: Zelis Auto |
$274.00
|
|
|
IMPLT TISSEEL 4ML
|
Facility
|
OP
|
$1,145.00
|
|
|
Service Code
|
CPT C1760
|
| Hospital Charge Code |
7001700
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$286.25 |
| Max. Negotiated Rate |
$1,087.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$687.00
|
| Rate for Payer: Cash Price |
$687.00
|
| Rate for Payer: Cash Price |
$687.00
|
| Rate for Payer: Cigna Commercial |
$973.25
|
| Rate for Payer: First Health Commercial |
$1,030.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,030.50
|
| Rate for Payer: GEHA Commercial |
$916.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,030.50
|
| Rate for Payer: Humana ChoiceCare |
$297.70
|
| Rate for Payer: Multiplan All |
$1,041.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$687.00
|
| Rate for Payer: OMNI Networks Commercial |
$801.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,030.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,087.75
|
| Rate for Payer: Three Rivers Provider Network All |
$858.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,007.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$286.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,064.85
|
| Rate for Payer: Zelis Auto |
$458.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$572.50
|
|
|
IMPLT TISSEEL 4ML
|
Facility
|
IP
|
$1,145.00
|
|
|
Service Code
|
CPT C1760
|
| Hospital Charge Code |
7001700
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$458.00 |
| Max. Negotiated Rate |
$1,087.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$916.00
|
| Rate for Payer: Cash Price |
$687.00
|
| Rate for Payer: Cash Price |
$687.00
|
| Rate for Payer: Cigna Commercial |
$973.25
|
| Rate for Payer: First Health Commercial |
$1,030.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,030.50
|
| Rate for Payer: GEHA Commercial |
$801.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,030.50
|
| Rate for Payer: Multiplan All |
$1,041.95
|
| Rate for Payer: OMNI Networks Commercial |
$801.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,030.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,087.75
|
| Rate for Payer: Three Rivers Provider Network All |
$858.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,064.85
|
| Rate for Payer: Zelis Auto |
$458.00
|
|
|
IMPLT TISSUE GRAFTJACKET 4X4CM
|
Facility
|
OP
|
$5,373.00
|
|
|
Service Code
|
CPT Q4107
|
| Hospital Charge Code |
7002461
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.62 |
| Max. Negotiated Rate |
$5,104.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,223.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$116.62
|
| Rate for Payer: Cash Price |
$3,223.80
|
| Rate for Payer: Cash Price |
$3,223.80
|
| Rate for Payer: Cash Price |
$3,223.80
|
| Rate for Payer: Cigna Commercial |
$4,567.05
|
| Rate for Payer: First Health Commercial |
$4,835.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,835.70
|
| Rate for Payer: GEHA Commercial |
$4,298.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,835.70
|
| Rate for Payer: Humana ChoiceCare |
$1,396.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$118.99
|
| Rate for Payer: Multiplan All |
$4,889.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,223.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,761.10
|
| Rate for Payer: One Health Plan PPO/POS |
$4,835.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$118.99
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,104.35
|
| Rate for Payer: Three Rivers Provider Network All |
$4,029.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,728.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$118.99
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,996.89
|
| Rate for Payer: Zelis Auto |
$2,149.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,686.50
|
|
|
IMPLT TISSUE GRAFTJACKET 4X4CM
|
Facility
|
IP
|
$5,373.00
|
|
|
Service Code
|
CPT Q4107
|
| Hospital Charge Code |
7002461
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,149.20 |
| Max. Negotiated Rate |
$5,104.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,298.40
|
| Rate for Payer: Cash Price |
$3,223.80
|
| Rate for Payer: Cash Price |
$3,223.80
|
| Rate for Payer: Cigna Commercial |
$4,567.05
|
| Rate for Payer: First Health Commercial |
$4,835.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,835.70
|
| Rate for Payer: GEHA Commercial |
$3,761.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,835.70
|
| Rate for Payer: Multiplan All |
$4,889.43
|
| Rate for Payer: OMNI Networks Commercial |
$3,761.10
|
| Rate for Payer: One Health Plan PPO/POS |
$4,835.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,104.35
|
| Rate for Payer: Three Rivers Provider Network All |
$4,029.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,996.89
|
| Rate for Payer: Zelis Auto |
$2,149.20
|
|
|
IMPLT TISSUE GRAFTJACKET 4X8CM
|
Facility
|
OP
|
$9,982.00
|
|
|
Service Code
|
CPT Q4107
|
| Hospital Charge Code |
7002462
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.62 |
| Max. Negotiated Rate |
$9,482.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,989.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$116.62
|
| Rate for Payer: Cash Price |
$5,989.20
|
| Rate for Payer: Cash Price |
$5,989.20
|
| Rate for Payer: Cash Price |
$5,989.20
|
| Rate for Payer: Cigna Commercial |
$8,484.70
|
| Rate for Payer: First Health Commercial |
$8,983.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,983.80
|
| Rate for Payer: GEHA Commercial |
$7,985.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,983.80
|
| Rate for Payer: Humana ChoiceCare |
$2,595.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$118.99
|
| Rate for Payer: Multiplan All |
$9,083.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,989.20
|
| Rate for Payer: OMNI Networks Commercial |
$6,987.40
|
| Rate for Payer: One Health Plan PPO/POS |
$8,983.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$118.99
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9,482.90
|
| Rate for Payer: Three Rivers Provider Network All |
$7,486.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8,784.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$118.99
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9,283.26
|
| Rate for Payer: Zelis Auto |
$3,992.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,991.00
|
|
