|
IMPLT TRAY HUMERAL 44+5
|
Facility
|
IP
|
$7,503.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002320
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,001.20 |
| Max. Negotiated Rate |
$7,127.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,002.40
|
| Rate for Payer: Cash Price |
$4,501.80
|
| Rate for Payer: Cash Price |
$4,501.80
|
| Rate for Payer: Cigna Commercial |
$6,377.55
|
| Rate for Payer: First Health Commercial |
$6,752.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,752.70
|
| Rate for Payer: GEHA Commercial |
$5,252.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,752.70
|
| Rate for Payer: Multiplan All |
$6,827.73
|
| Rate for Payer: OMNI Networks Commercial |
$5,252.10
|
| Rate for Payer: One Health Plan PPO/POS |
$6,752.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,127.85
|
| Rate for Payer: Three Rivers Provider Network All |
$5,627.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,977.79
|
| Rate for Payer: Zelis Auto |
$3,001.20
|
|
|
IMPLT TRAY HUMERAL 44+5
|
Facility
|
OP
|
$7,503.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002320
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,875.75 |
| Max. Negotiated Rate |
$7,127.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,501.80
|
| Rate for Payer: Cash Price |
$4,501.80
|
| Rate for Payer: Cash Price |
$4,501.80
|
| Rate for Payer: Cigna Commercial |
$6,377.55
|
| Rate for Payer: First Health Commercial |
$6,752.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,752.70
|
| Rate for Payer: GEHA Commercial |
$6,002.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,752.70
|
| Rate for Payer: Humana ChoiceCare |
$1,950.78
|
| Rate for Payer: Multiplan All |
$6,827.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,501.80
|
| Rate for Payer: OMNI Networks Commercial |
$5,252.10
|
| Rate for Payer: One Health Plan PPO/POS |
$6,752.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,127.85
|
| Rate for Payer: Three Rivers Provider Network All |
$5,627.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,602.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,875.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,977.79
|
| Rate for Payer: Zelis Auto |
$3,001.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,751.50
|
|
|
IMPLT TRAY HUMERAL 44MM STANDARD
|
Facility
|
IP
|
$7,637.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002184
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,054.80 |
| Max. Negotiated Rate |
$7,255.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,109.60
|
| Rate for Payer: Cash Price |
$4,582.20
|
| Rate for Payer: Cash Price |
$4,582.20
|
| Rate for Payer: Cigna Commercial |
$6,491.45
|
| Rate for Payer: First Health Commercial |
$6,873.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,873.30
|
| Rate for Payer: GEHA Commercial |
$5,345.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,873.30
|
| Rate for Payer: Multiplan All |
$6,949.67
|
| Rate for Payer: OMNI Networks Commercial |
$5,345.90
|
| Rate for Payer: One Health Plan PPO/POS |
$6,873.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,255.15
|
| Rate for Payer: Three Rivers Provider Network All |
$5,727.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,102.41
|
| Rate for Payer: Zelis Auto |
$3,054.80
|
|
|
IMPLT TRAY HUMERAL 44MM STANDARD
|
Facility
|
OP
|
$7,637.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002184
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,909.25 |
| Max. Negotiated Rate |
$7,255.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,582.20
|
| Rate for Payer: Cash Price |
$4,582.20
|
| Rate for Payer: Cash Price |
$4,582.20
|
| Rate for Payer: Cigna Commercial |
$6,491.45
|
| Rate for Payer: First Health Commercial |
$6,873.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,873.30
|
| Rate for Payer: GEHA Commercial |
$6,109.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,873.30
|
| Rate for Payer: Humana ChoiceCare |
$1,985.62
|
| Rate for Payer: Multiplan All |
$6,949.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,582.20
|
| Rate for Payer: OMNI Networks Commercial |
$5,345.90
|
| Rate for Payer: One Health Plan PPO/POS |
$6,873.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,255.15
|
| Rate for Payer: Three Rivers Provider Network All |
$5,727.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,720.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,909.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,102.41
|
| Rate for Payer: Zelis Auto |
$3,054.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,818.50
|
|
|
IMPLT TRAY PICC NXT CLEARVUE
|
Facility
|
OP
|
$854.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
7001685
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$213.50 |
| Max. Negotiated Rate |
$811.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$512.40
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$725.90
|
| Rate for Payer: First Health Commercial |
$768.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$768.60
|
| Rate for Payer: GEHA Commercial |
$683.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$768.60
|
| Rate for Payer: Humana ChoiceCare |
$222.04
|
| Rate for Payer: Multiplan All |
$777.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$512.40
|
| Rate for Payer: OMNI Networks Commercial |
$597.80
|
| Rate for Payer: One Health Plan PPO/POS |
$768.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$811.30
|
| Rate for Payer: Three Rivers Provider Network All |
$640.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$751.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$213.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$794.22
|
| Rate for Payer: Zelis Auto |
$341.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$427.00
|
|
|
IMPLT TRAY PICC NXT CLEARVUE
|
Facility
|
IP
|
$854.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
7001685
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$341.60 |
| Max. Negotiated Rate |
$811.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$683.20
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$725.90
|
| Rate for Payer: First Health Commercial |
$768.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$768.60
|
| Rate for Payer: GEHA Commercial |
$597.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$768.60
|
| Rate for Payer: Multiplan All |
$777.14
|
| Rate for Payer: OMNI Networks Commercial |
$597.80
|
| Rate for Payer: One Health Plan PPO/POS |
$768.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$811.30
|
| Rate for Payer: Three Rivers Provider Network All |
$640.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$794.22
|
| Rate for Payer: Zelis Auto |
$341.60
|
|
|
IMPLT TRAY PLATFORM TIBIAL SIZE 5
|
Facility
|
OP
|
$9,860.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002181
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,465.00 |
| Max. Negotiated Rate |
$9,367.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,916.00
|
| Rate for Payer: Cash Price |
$5,916.00
|
| Rate for Payer: Cash Price |
$5,916.00
|
| Rate for Payer: Cigna Commercial |
$8,381.00
|
| Rate for Payer: First Health Commercial |
$8,874.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,874.00
|
| Rate for Payer: GEHA Commercial |
$7,888.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,874.00
|
| Rate for Payer: Humana ChoiceCare |
$2,563.60
|
| Rate for Payer: Multiplan All |
$8,972.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,916.00
|
| Rate for Payer: OMNI Networks Commercial |
$6,902.00
|
| Rate for Payer: One Health Plan PPO/POS |
$8,874.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9,367.00
|
| Rate for Payer: Three Rivers Provider Network All |
$7,395.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8,676.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,465.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9,169.80
|
| Rate for Payer: Zelis Auto |
$3,944.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,930.00
|
|
|
IMPLT TRAY PLATFORM TIBIAL SIZE 5
|
Facility
|
IP
|
$9,860.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002181
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,944.00 |
| Max. Negotiated Rate |
$9,367.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7,888.00
|
| Rate for Payer: Cash Price |
$5,916.00
|
| Rate for Payer: Cash Price |
$5,916.00
|
| Rate for Payer: Cigna Commercial |
$8,381.00
|
| Rate for Payer: First Health Commercial |
$8,874.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,874.00
|
| Rate for Payer: GEHA Commercial |
$6,902.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,874.00
|
| Rate for Payer: Multiplan All |
$8,972.60
|
| Rate for Payer: OMNI Networks Commercial |
$6,902.00
|
| Rate for Payer: One Health Plan PPO/POS |
$8,874.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9,367.00
|
| Rate for Payer: Three Rivers Provider Network All |
$7,395.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9,169.80
|
| Rate for Payer: Zelis Auto |
$3,944.00
|
|
|
IMPLT TRAY TIBIAL CEMENT ROTATING SIZE 6
|
Facility
|
IP
|
$9,520.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002182
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,808.00 |
| Max. Negotiated Rate |
$9,044.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7,616.00
|
| Rate for Payer: Cash Price |
$5,712.00
|
| Rate for Payer: Cash Price |
$5,712.00
|
| Rate for Payer: Cigna Commercial |
$8,092.00
|
| Rate for Payer: First Health Commercial |
$8,568.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,568.00
|
| Rate for Payer: GEHA Commercial |
$6,664.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,568.00
|
| Rate for Payer: Multiplan All |
$8,663.20
|
| Rate for Payer: OMNI Networks Commercial |
$6,664.00
|
| Rate for Payer: One Health Plan PPO/POS |
$8,568.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9,044.00
|
| Rate for Payer: Three Rivers Provider Network All |
$7,140.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,853.60
|
| Rate for Payer: Zelis Auto |
$3,808.00
|
|
|
IMPLT TRAY TIBIAL CEMENT ROTATING SIZE 6
|
Facility
|
OP
|
$9,520.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002182
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,380.00 |
| Max. Negotiated Rate |
$9,044.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,712.00
|
| Rate for Payer: Cash Price |
$5,712.00
|
| Rate for Payer: Cash Price |
$5,712.00
|
| Rate for Payer: Cigna Commercial |
$8,092.00
|
| Rate for Payer: First Health Commercial |
$8,568.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,568.00
|
| Rate for Payer: GEHA Commercial |
$7,616.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,568.00
|
| Rate for Payer: Humana ChoiceCare |
$2,475.20
|
| Rate for Payer: Multiplan All |
$8,663.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,712.00
|
| Rate for Payer: OMNI Networks Commercial |
$6,664.00
|
| Rate for Payer: One Health Plan PPO/POS |
$8,568.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9,044.00
|
| Rate for Payer: Three Rivers Provider Network All |
$7,140.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8,377.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,380.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,853.60
|
| Rate for Payer: Zelis Auto |
$3,808.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,760.00
|
|
|
IMPLT TRAY TIBIAL KNEE 3 SIZE
|
Facility
|
IP
|
$9,860.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002183
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,944.00 |
| Max. Negotiated Rate |
$9,367.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7,888.00
|
| Rate for Payer: Cash Price |
$5,916.00
|
| Rate for Payer: Cash Price |
$5,916.00
|
| Rate for Payer: Cigna Commercial |
$8,381.00
|
| Rate for Payer: First Health Commercial |
$8,874.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,874.00
|
| Rate for Payer: GEHA Commercial |
$6,902.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,874.00
|
| Rate for Payer: Multiplan All |
$8,972.60
|
| Rate for Payer: OMNI Networks Commercial |
$6,902.00
|
| Rate for Payer: One Health Plan PPO/POS |
$8,874.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9,367.00
|
| Rate for Payer: Three Rivers Provider Network All |
$7,395.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9,169.80
|
| Rate for Payer: Zelis Auto |
$3,944.00
|
|
|
IMPLT TRAY TIBIAL KNEE 3 SIZE
|
Facility
|
OP
|
$9,860.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002183
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,465.00 |
| Max. Negotiated Rate |
$9,367.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,916.00
|
| Rate for Payer: Cash Price |
$5,916.00
|
| Rate for Payer: Cash Price |
$5,916.00
|
| Rate for Payer: Cigna Commercial |
$8,381.00
|
| Rate for Payer: First Health Commercial |
$8,874.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,874.00
|
| Rate for Payer: GEHA Commercial |
$7,888.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,874.00
|
| Rate for Payer: Humana ChoiceCare |
$2,563.60
|
| Rate for Payer: Multiplan All |
$8,972.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,916.00
|
| Rate for Payer: OMNI Networks Commercial |
$6,902.00
|
| Rate for Payer: One Health Plan PPO/POS |
$8,874.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9,367.00
|
| Rate for Payer: Three Rivers Provider Network All |
$7,395.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8,676.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,465.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9,169.80
|
| Rate for Payer: Zelis Auto |
$3,944.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,930.00
|
|
|
IMPLT TRAY TIBIAL OFFEST 71MM
|
Facility
|
IP
|
$1,106.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002319
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$442.40 |
| Max. Negotiated Rate |
$1,050.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$884.80
|
| Rate for Payer: Cash Price |
$663.60
|
| Rate for Payer: Cash Price |
$663.60
|
| Rate for Payer: Cigna Commercial |
$940.10
|
| Rate for Payer: First Health Commercial |
$995.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$995.40
|
| Rate for Payer: GEHA Commercial |
$774.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$995.40
|
| Rate for Payer: Multiplan All |
$1,006.46
|
| Rate for Payer: OMNI Networks Commercial |
$774.20
|
| Rate for Payer: One Health Plan PPO/POS |
$995.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,050.70
|
| Rate for Payer: Three Rivers Provider Network All |
$829.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,028.58
|
| Rate for Payer: Zelis Auto |
$442.40
|
|
|
IMPLT TRAY TIBIAL OFFEST 71MM
|
Facility
|
OP
|
$1,106.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002319
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$276.50 |
| Max. Negotiated Rate |
$1,050.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$663.60
|
| Rate for Payer: Cash Price |
$663.60
|
| Rate for Payer: Cash Price |
$663.60
|
| Rate for Payer: Cigna Commercial |
$940.10
|
| Rate for Payer: First Health Commercial |
$995.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$995.40
|
| Rate for Payer: GEHA Commercial |
$884.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$995.40
|
| Rate for Payer: Humana ChoiceCare |
$287.56
|
| Rate for Payer: Multiplan All |
$1,006.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$663.60
|
| Rate for Payer: OMNI Networks Commercial |
$774.20
|
| Rate for Payer: One Health Plan PPO/POS |
$995.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,050.70
|
| Rate for Payer: Three Rivers Provider Network All |
$829.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$973.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$276.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,028.58
|
| Rate for Payer: Zelis Auto |
$442.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$553.00
|
|
|
IMPLT TRAY TIBIAL PLATFORM SIZE 4
|
Facility
|
OP
|
$9,520.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002185
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,380.00 |
| Max. Negotiated Rate |
$9,044.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,712.00
|
| Rate for Payer: Cash Price |
$5,712.00
|
| Rate for Payer: Cash Price |
$5,712.00
|
| Rate for Payer: Cigna Commercial |
$8,092.00
|
| Rate for Payer: First Health Commercial |
$8,568.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,568.00
|
| Rate for Payer: GEHA Commercial |
$7,616.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,568.00
|
| Rate for Payer: Humana ChoiceCare |
$2,475.20
|
| Rate for Payer: Multiplan All |
$8,663.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,712.00
|
| Rate for Payer: OMNI Networks Commercial |
$6,664.00
|
| Rate for Payer: One Health Plan PPO/POS |
$8,568.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9,044.00
|
| Rate for Payer: Three Rivers Provider Network All |
$7,140.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8,377.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,380.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,853.60
|
| Rate for Payer: Zelis Auto |
$3,808.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,760.00
|
|
|
IMPLT TRAY TIBIAL PLATFORM SIZE 4
|
Facility
|
IP
|
$9,520.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002185
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,808.00 |
| Max. Negotiated Rate |
$9,044.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7,616.00
|
| Rate for Payer: Cash Price |
$5,712.00
|
| Rate for Payer: Cash Price |
$5,712.00
|
| Rate for Payer: Cigna Commercial |
$8,092.00
|
| Rate for Payer: First Health Commercial |
$8,568.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,568.00
|
| Rate for Payer: GEHA Commercial |
$6,664.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,568.00
|
| Rate for Payer: Multiplan All |
$8,663.20
|
| Rate for Payer: OMNI Networks Commercial |
$6,664.00
|
| Rate for Payer: One Health Plan PPO/POS |
$8,568.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9,044.00
|
| Rate for Payer: Three Rivers Provider Network All |
$7,140.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,853.60
|
| Rate for Payer: Zelis Auto |
$3,808.00
|
|
|
IMPLT TRAY TIBIAL SIZE 5
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002321
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$299.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$267.75
|
| Rate for Payer: First Health Commercial |
$283.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$283.50
|
| Rate for Payer: GEHA Commercial |
$252.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$283.50
|
| Rate for Payer: Humana ChoiceCare |
$81.90
|
| Rate for Payer: Multiplan All |
$286.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$189.00
|
| Rate for Payer: OMNI Networks Commercial |
$220.50
|
| Rate for Payer: One Health Plan PPO/POS |
$283.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$299.25
|
| Rate for Payer: Three Rivers Provider Network All |
$236.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$277.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$78.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$292.95
|
| Rate for Payer: Zelis Auto |
$126.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$157.50
|
|
|
IMPLT TRAY TIBIAL SIZE 5
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002321
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$299.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$252.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$267.75
|
| Rate for Payer: First Health Commercial |
$283.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$283.50
|
| Rate for Payer: GEHA Commercial |
$220.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$283.50
|
| Rate for Payer: Multiplan All |
$286.65
|
| Rate for Payer: OMNI Networks Commercial |
$220.50
|
| Rate for Payer: One Health Plan PPO/POS |
$283.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$299.25
|
| Rate for Payer: Three Rivers Provider Network All |
$236.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$292.95
|
| Rate for Payer: Zelis Auto |
$126.00
|
|
|
IMPLT TRIAL SCREENING LEAD KIT
|
Facility
|
IP
|
$4,994.00
|
|
|
Service Code
|
CPT C1787
|
| Hospital Charge Code |
7003168
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,997.60 |
| Max. Negotiated Rate |
$4,744.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,995.20
|
| Rate for Payer: Cash Price |
$2,996.40
|
| Rate for Payer: Cash Price |
$2,996.40
|
| Rate for Payer: Cigna Commercial |
$4,244.90
|
| Rate for Payer: First Health Commercial |
$4,494.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,494.60
|
| Rate for Payer: GEHA Commercial |
$3,495.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,494.60
|
| Rate for Payer: Multiplan All |
$4,544.54
|
| Rate for Payer: OMNI Networks Commercial |
$3,495.80
|
| Rate for Payer: One Health Plan PPO/POS |
$4,494.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,744.30
|
| Rate for Payer: Three Rivers Provider Network All |
$3,745.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,644.42
|
| Rate for Payer: Zelis Auto |
$1,997.60
|
|
|
IMPLT TRIAL SCREENING LEAD KIT
|
Facility
|
OP
|
$4,994.00
|
|
|
Service Code
|
CPT C1787
|
| Hospital Charge Code |
7003168
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,248.50 |
| Max. Negotiated Rate |
$4,744.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,996.40
|
| Rate for Payer: Cash Price |
$2,996.40
|
| Rate for Payer: Cash Price |
$2,996.40
|
| Rate for Payer: Cigna Commercial |
$4,244.90
|
| Rate for Payer: First Health Commercial |
$4,494.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,494.60
|
| Rate for Payer: GEHA Commercial |
$3,995.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,494.60
|
| Rate for Payer: Humana ChoiceCare |
$1,298.44
|
| Rate for Payer: Multiplan All |
$4,544.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,996.40
|
| Rate for Payer: OMNI Networks Commercial |
$3,495.80
|
| Rate for Payer: One Health Plan PPO/POS |
$4,494.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,744.30
|
| Rate for Payer: Three Rivers Provider Network All |
$3,745.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,394.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,248.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,644.42
|
| Rate for Payer: Zelis Auto |
$1,997.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,497.00
|
|
|
IMPLT TRIAL SPACER TENDON ROD HUNTER
|
Facility
|
OP
|
$2,948.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002186
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$737.00 |
| Max. Negotiated Rate |
$2,800.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,768.80
|
| Rate for Payer: Cash Price |
$1,768.80
|
| Rate for Payer: Cash Price |
$1,768.80
|
| Rate for Payer: Cigna Commercial |
$2,505.80
|
| Rate for Payer: First Health Commercial |
$2,653.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,653.20
|
| Rate for Payer: GEHA Commercial |
$2,358.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,653.20
|
| Rate for Payer: Humana ChoiceCare |
$766.48
|
| Rate for Payer: Multiplan All |
$2,682.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,768.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,063.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,653.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,800.60
|
| Rate for Payer: Three Rivers Provider Network All |
$2,211.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,594.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$737.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,741.64
|
| Rate for Payer: Zelis Auto |
$1,179.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,474.00
|
|
|
IMPLT TRIAL SPACER TENDON ROD HUNTER
|
Facility
|
IP
|
$2,948.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002186
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,179.20 |
| Max. Negotiated Rate |
$2,800.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,358.40
|
| Rate for Payer: Cash Price |
$1,768.80
|
| Rate for Payer: Cash Price |
$1,768.80
|
| Rate for Payer: Cigna Commercial |
$2,505.80
|
| Rate for Payer: First Health Commercial |
$2,653.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,653.20
|
| Rate for Payer: GEHA Commercial |
$2,063.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,653.20
|
| Rate for Payer: Multiplan All |
$2,682.68
|
| Rate for Payer: OMNI Networks Commercial |
$2,063.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,653.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,800.60
|
| Rate for Payer: Three Rivers Provider Network All |
$2,211.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,741.64
|
| Rate for Payer: Zelis Auto |
$1,179.20
|
|
|
IMPLT TRIAL TOE FLEXIBLE SWANSON SMALL
|
Facility
|
IP
|
$2,652.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,060.80 |
| Max. Negotiated Rate |
$2,519.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,121.60
|
| Rate for Payer: Cash Price |
$1,591.20
|
| Rate for Payer: Cash Price |
$1,591.20
|
| Rate for Payer: Cigna Commercial |
$2,254.20
|
| Rate for Payer: First Health Commercial |
$2,386.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,386.80
|
| Rate for Payer: GEHA Commercial |
$1,856.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,386.80
|
| Rate for Payer: Multiplan All |
$2,413.32
|
| Rate for Payer: OMNI Networks Commercial |
$1,856.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,386.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,519.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,989.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,466.36
|
| Rate for Payer: Zelis Auto |
$1,060.80
|
|
|
IMPLT TRIAL TOE FLEXIBLE SWANSON SMALL
|
Facility
|
OP
|
$2,652.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$663.00 |
| Max. Negotiated Rate |
$2,519.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,591.20
|
| Rate for Payer: Cash Price |
$1,591.20
|
| Rate for Payer: Cash Price |
$1,591.20
|
| Rate for Payer: Cigna Commercial |
$2,254.20
|
| Rate for Payer: First Health Commercial |
$2,386.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,386.80
|
| Rate for Payer: GEHA Commercial |
$2,121.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,386.80
|
| Rate for Payer: Humana ChoiceCare |
$689.52
|
| Rate for Payer: Multiplan All |
$2,413.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,591.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,856.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,386.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,519.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,989.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,333.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$663.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,466.36
|
| Rate for Payer: Zelis Auto |
$1,060.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,326.00
|
|
|
IMPLT TRIA SOFT 6 X 20
|
Facility
|
IP
|
$1,022.12
|
|
|
Service Code
|
CPT C2617
|
| Hospital Charge Code |
7005208
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$408.85 |
| Max. Negotiated Rate |
$971.01 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$817.70
|
| Rate for Payer: Cash Price |
$613.27
|
| Rate for Payer: Cash Price |
$613.27
|
| Rate for Payer: Cigna Commercial |
$868.80
|
| Rate for Payer: First Health Commercial |
$919.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$919.91
|
| Rate for Payer: GEHA Commercial |
$715.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$919.91
|
| Rate for Payer: Multiplan All |
$930.13
|
| Rate for Payer: OMNI Networks Commercial |
$715.48
|
| Rate for Payer: One Health Plan PPO/POS |
$919.91
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$971.01
|
| Rate for Payer: Three Rivers Provider Network All |
$766.59
|
| Rate for Payer: United Payors & United Providers UP&UP |
$950.57
|
| Rate for Payer: Zelis Auto |
$408.85
|
|
