|
IMPLT LNQ22 REVEAL LOOP RECORDER
|
Facility
|
IP
|
$16,885.00
|
|
|
Service Code
|
CPT C1764
|
| Hospital Charge Code |
7006665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,754.00 |
| Max. Negotiated Rate |
$16,040.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$13,508.00
|
| Rate for Payer: Cash Price |
$10,131.00
|
| Rate for Payer: Cash Price |
$10,131.00
|
| Rate for Payer: Cigna Commercial |
$14,352.25
|
| Rate for Payer: First Health Commercial |
$15,196.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$15,196.50
|
| Rate for Payer: GEHA Commercial |
$11,819.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$15,196.50
|
| Rate for Payer: Multiplan All |
$15,365.35
|
| Rate for Payer: OMNI Networks Commercial |
$11,819.50
|
| Rate for Payer: One Health Plan PPO/POS |
$15,196.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$16,040.75
|
| Rate for Payer: Three Rivers Provider Network All |
$12,663.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$15,703.05
|
| Rate for Payer: Zelis Auto |
$6,754.00
|
|
|
IMPLT LOCKING NON 2.7X22MM
|
Facility
|
OP
|
$655.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006229
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$163.75 |
| Max. Negotiated Rate |
$622.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$393.00
|
| Rate for Payer: Cash Price |
$393.00
|
| Rate for Payer: Cash Price |
$393.00
|
| Rate for Payer: Cigna Commercial |
$556.75
|
| Rate for Payer: First Health Commercial |
$589.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$589.50
|
| Rate for Payer: GEHA Commercial |
$524.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$589.50
|
| Rate for Payer: Humana ChoiceCare |
$170.30
|
| Rate for Payer: Multiplan All |
$596.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$393.00
|
| Rate for Payer: OMNI Networks Commercial |
$458.50
|
| Rate for Payer: One Health Plan PPO/POS |
$589.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$622.25
|
| Rate for Payer: Three Rivers Provider Network All |
$491.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$576.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$163.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$609.15
|
| Rate for Payer: Zelis Auto |
$262.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$327.50
|
|
|
IMPLT LOCKING NON 2.7X22MM
|
Facility
|
IP
|
$655.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006229
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.00 |
| Max. Negotiated Rate |
$622.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$524.00
|
| Rate for Payer: Cash Price |
$393.00
|
| Rate for Payer: Cash Price |
$393.00
|
| Rate for Payer: Cigna Commercial |
$556.75
|
| Rate for Payer: First Health Commercial |
$589.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$589.50
|
| Rate for Payer: GEHA Commercial |
$458.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$589.50
|
| Rate for Payer: Multiplan All |
$596.05
|
| Rate for Payer: OMNI Networks Commercial |
$458.50
|
| Rate for Payer: One Health Plan PPO/POS |
$589.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$622.25
|
| Rate for Payer: Three Rivers Provider Network All |
$491.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$609.15
|
| Rate for Payer: Zelis Auto |
$262.00
|
|
|
IMPLT LOCKING SCREW 5 X 32.5MM
|
Facility
|
OP
|
$958.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009280
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$239.60 |
| Max. Negotiated Rate |
$910.48 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$575.04
|
| Rate for Payer: Cash Price |
$575.04
|
| Rate for Payer: Cash Price |
$575.04
|
| Rate for Payer: Cigna Commercial |
$814.64
|
| Rate for Payer: First Health Commercial |
$862.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$862.56
|
| Rate for Payer: GEHA Commercial |
$766.72
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$862.56
|
| Rate for Payer: Humana ChoiceCare |
$249.18
|
| Rate for Payer: Multiplan All |
$872.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$575.04
|
| Rate for Payer: OMNI Networks Commercial |
$670.88
|
| Rate for Payer: One Health Plan PPO/POS |
$862.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$910.48
|
| Rate for Payer: Three Rivers Provider Network All |
$718.80
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$843.39
|
| Rate for Payer: United Healthcare Managed Medicaid |
$239.60
|
| Rate for Payer: United Payors & United Providers UP&UP |
$891.31
|
| Rate for Payer: Zelis Auto |
$383.36
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$479.20
|
|
|
IMPLT LOCKING SCREW 5 X 32.5MM
|
Facility
|
IP
|
$958.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009280
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$383.36 |
| Max. Negotiated Rate |
$910.48 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$766.72
|
| Rate for Payer: Cash Price |
$575.04
|
| Rate for Payer: Cash Price |
$575.04
|
| Rate for Payer: Cigna Commercial |
$814.64
|
| Rate for Payer: First Health Commercial |
$862.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$862.56
|
| Rate for Payer: GEHA Commercial |
$670.88
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$862.56
|
| Rate for Payer: Multiplan All |
$872.14
|
| Rate for Payer: OMNI Networks Commercial |
$670.88
|
| Rate for Payer: One Health Plan PPO/POS |
$862.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$910.48
|
| Rate for Payer: Three Rivers Provider Network All |
$718.80
|
| Rate for Payer: United Payors & United Providers UP&UP |
$891.31
|
| Rate for Payer: Zelis Auto |
$383.36
|
|
|
IMPLT LOCKING SCREW 5 X 45MM
|
Facility
|
IP
|
$958.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009281
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$383.36 |
| Max. Negotiated Rate |
$910.48 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$766.72
|
| Rate for Payer: Cash Price |
$575.04
|
| Rate for Payer: Cash Price |
$575.04
|
| Rate for Payer: Cigna Commercial |
$814.64
|
| Rate for Payer: First Health Commercial |
$862.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$862.56
|
| Rate for Payer: GEHA Commercial |
$670.88
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$862.56
|
| Rate for Payer: Multiplan All |
$872.14
|
| Rate for Payer: OMNI Networks Commercial |
$670.88
|
| Rate for Payer: One Health Plan PPO/POS |
$862.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$910.48
|
| Rate for Payer: Three Rivers Provider Network All |
$718.80
|
| Rate for Payer: United Payors & United Providers UP&UP |
$891.31
|
| Rate for Payer: Zelis Auto |
$383.36
|
|
|
IMPLT LOCKING SCREW 5 X 45MM
|
Facility
|
OP
|
$958.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009281
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$239.60 |
| Max. Negotiated Rate |
$910.48 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$575.04
|
| Rate for Payer: Cash Price |
$575.04
|
| Rate for Payer: Cash Price |
$575.04
|
| Rate for Payer: Cigna Commercial |
$814.64
|
| Rate for Payer: First Health Commercial |
$862.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$862.56
|
| Rate for Payer: GEHA Commercial |
$766.72
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$862.56
|
| Rate for Payer: Humana ChoiceCare |
$249.18
|
| Rate for Payer: Multiplan All |
$872.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$575.04
|
| Rate for Payer: OMNI Networks Commercial |
$670.88
|
| Rate for Payer: One Health Plan PPO/POS |
$862.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$910.48
|
| Rate for Payer: Three Rivers Provider Network All |
$718.80
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$843.39
|
| Rate for Payer: United Healthcare Managed Medicaid |
$239.60
|
| Rate for Payer: United Payors & United Providers UP&UP |
$891.31
|
| Rate for Payer: Zelis Auto |
$383.36
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$479.20
|
|
|
IMPLT MATRIX BONE VIABLE 10CC
|
Facility
|
IP
|
$20,249.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002625
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,099.60 |
| Max. Negotiated Rate |
$19,236.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$16,199.20
|
| Rate for Payer: Cash Price |
$12,149.40
|
| Rate for Payer: Cash Price |
$12,149.40
|
| Rate for Payer: Cigna Commercial |
$17,211.65
|
| Rate for Payer: First Health Commercial |
$18,224.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$18,224.10
|
| Rate for Payer: GEHA Commercial |
$14,174.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$18,224.10
|
| Rate for Payer: Multiplan All |
$18,426.59
|
| Rate for Payer: OMNI Networks Commercial |
$14,174.30
|
| Rate for Payer: One Health Plan PPO/POS |
$18,224.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$19,236.55
|
| Rate for Payer: Three Rivers Provider Network All |
$15,186.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$18,831.57
|
| Rate for Payer: Zelis Auto |
$8,099.60
|
|
|
IMPLT MATRIX BONE VIABLE 10CC
|
Facility
|
OP
|
$20,249.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002625
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,062.25 |
| Max. Negotiated Rate |
$19,236.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$12,149.40
|
| Rate for Payer: Cash Price |
$12,149.40
|
| Rate for Payer: Cash Price |
$12,149.40
|
| Rate for Payer: Cigna Commercial |
$17,211.65
|
| Rate for Payer: First Health Commercial |
$18,224.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$18,224.10
|
| Rate for Payer: GEHA Commercial |
$16,199.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$18,224.10
|
| Rate for Payer: Humana ChoiceCare |
$5,264.74
|
| Rate for Payer: Multiplan All |
$18,426.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$12,149.40
|
| Rate for Payer: OMNI Networks Commercial |
$14,174.30
|
| Rate for Payer: One Health Plan PPO/POS |
$18,224.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$19,236.55
|
| Rate for Payer: Three Rivers Provider Network All |
$15,186.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17,819.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,062.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$18,831.57
|
| Rate for Payer: Zelis Auto |
$8,099.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10,124.50
|
|
|
IMPLT MATRIX BONE VIABLE 5CC
|
Facility
|
IP
|
$12,180.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002626
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,872.00 |
| Max. Negotiated Rate |
$11,571.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9,744.00
|
| Rate for Payer: Cash Price |
$7,308.00
|
| Rate for Payer: Cash Price |
$7,308.00
|
| Rate for Payer: Cigna Commercial |
$10,353.00
|
| Rate for Payer: First Health Commercial |
$10,962.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10,962.00
|
| Rate for Payer: GEHA Commercial |
$8,526.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10,962.00
|
| Rate for Payer: Multiplan All |
$11,083.80
|
| Rate for Payer: OMNI Networks Commercial |
$8,526.00
|
| Rate for Payer: One Health Plan PPO/POS |
$10,962.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$11,571.00
|
| Rate for Payer: Three Rivers Provider Network All |
$9,135.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$11,327.40
|
| Rate for Payer: Zelis Auto |
$4,872.00
|
|
|
IMPLT MATRIX BONE VIABLE 5CC
|
Facility
|
OP
|
$12,180.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002626
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,045.00 |
| Max. Negotiated Rate |
$11,571.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7,308.00
|
| Rate for Payer: Cash Price |
$7,308.00
|
| Rate for Payer: Cash Price |
$7,308.00
|
| Rate for Payer: Cigna Commercial |
$10,353.00
|
| Rate for Payer: First Health Commercial |
$10,962.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10,962.00
|
| Rate for Payer: GEHA Commercial |
$9,744.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10,962.00
|
| Rate for Payer: Humana ChoiceCare |
$3,166.80
|
| Rate for Payer: Multiplan All |
$11,083.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7,308.00
|
| Rate for Payer: OMNI Networks Commercial |
$8,526.00
|
| Rate for Payer: One Health Plan PPO/POS |
$10,962.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$11,571.00
|
| Rate for Payer: Three Rivers Provider Network All |
$9,135.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10,718.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,045.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$11,327.40
|
| Rate for Payer: Zelis Auto |
$4,872.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,090.00
|
|
|
IMPLT MESH COMPOSIX E/X 10X13
|
Facility
|
IP
|
$5,601.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002330
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,240.40 |
| Max. Negotiated Rate |
$5,320.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,480.80
|
| Rate for Payer: Cash Price |
$3,360.60
|
| Rate for Payer: Cash Price |
$3,360.60
|
| Rate for Payer: Cigna Commercial |
$4,760.85
|
| Rate for Payer: First Health Commercial |
$5,040.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,040.90
|
| Rate for Payer: GEHA Commercial |
$3,920.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,040.90
|
| Rate for Payer: Multiplan All |
$5,096.91
|
| Rate for Payer: OMNI Networks Commercial |
$3,920.70
|
| Rate for Payer: One Health Plan PPO/POS |
$5,040.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,320.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,200.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,208.93
|
| Rate for Payer: Zelis Auto |
$2,240.40
|
|
|
IMPLT MESH COMPOSIX E/X 10X13
|
Facility
|
OP
|
$5,601.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002330
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,400.25 |
| Max. Negotiated Rate |
$5,320.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,360.60
|
| Rate for Payer: Cash Price |
$3,360.60
|
| Rate for Payer: Cash Price |
$3,360.60
|
| Rate for Payer: Cigna Commercial |
$4,760.85
|
| Rate for Payer: First Health Commercial |
$5,040.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,040.90
|
| Rate for Payer: GEHA Commercial |
$4,480.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,040.90
|
| Rate for Payer: Humana ChoiceCare |
$1,456.26
|
| Rate for Payer: Multiplan All |
$5,096.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,360.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,920.70
|
| Rate for Payer: One Health Plan PPO/POS |
$5,040.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,320.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,200.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,928.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,400.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,208.93
|
| Rate for Payer: Zelis Auto |
$2,240.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,800.50
|
|
|
IMPLT MESH COMPOSIX E/X 6X8
|
Facility
|
OP
|
$3,048.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002331
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$762.00 |
| Max. Negotiated Rate |
$2,895.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,828.80
|
| Rate for Payer: Cash Price |
$1,828.80
|
| Rate for Payer: Cash Price |
$1,828.80
|
| Rate for Payer: Cigna Commercial |
$2,590.80
|
| Rate for Payer: First Health Commercial |
$2,743.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,743.20
|
| Rate for Payer: GEHA Commercial |
$2,438.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,743.20
|
| Rate for Payer: Humana ChoiceCare |
$792.48
|
| Rate for Payer: Multiplan All |
$2,773.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,828.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,133.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,743.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,895.60
|
| Rate for Payer: Three Rivers Provider Network All |
$2,286.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,682.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$762.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,834.64
|
| Rate for Payer: Zelis Auto |
$1,219.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,524.00
|
|
|
IMPLT MESH COMPOSIX E/X 6X8
|
Facility
|
IP
|
$3,048.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002331
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,219.20 |
| Max. Negotiated Rate |
$2,895.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,438.40
|
| Rate for Payer: Cash Price |
$1,828.80
|
| Rate for Payer: Cash Price |
$1,828.80
|
| Rate for Payer: Cigna Commercial |
$2,590.80
|
| Rate for Payer: First Health Commercial |
$2,743.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,743.20
|
| Rate for Payer: GEHA Commercial |
$2,133.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,743.20
|
| Rate for Payer: Multiplan All |
$2,773.68
|
| Rate for Payer: OMNI Networks Commercial |
$2,133.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,743.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,895.60
|
| Rate for Payer: Three Rivers Provider Network All |
$2,286.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,834.64
|
| Rate for Payer: Zelis Auto |
$1,219.20
|
|
|
IMPLT MESH COMPOSIX E/X 7X9
|
Facility
|
OP
|
$3,785.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002332
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$946.25 |
| Max. Negotiated Rate |
$3,595.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,271.00
|
| Rate for Payer: Cash Price |
$2,271.00
|
| Rate for Payer: Cash Price |
$2,271.00
|
| Rate for Payer: Cigna Commercial |
$3,217.25
|
| Rate for Payer: First Health Commercial |
$3,406.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,406.50
|
| Rate for Payer: GEHA Commercial |
$3,028.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,406.50
|
| Rate for Payer: Humana ChoiceCare |
$984.10
|
| Rate for Payer: Multiplan All |
$3,444.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,271.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,649.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,406.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,595.75
|
| Rate for Payer: Three Rivers Provider Network All |
$2,838.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,330.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$946.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,520.05
|
| Rate for Payer: Zelis Auto |
$1,514.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,892.50
|
|
|
IMPLT MESH COMPOSIX E/X 7X9
|
Facility
|
IP
|
$3,785.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002332
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,514.00 |
| Max. Negotiated Rate |
$3,595.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,028.00
|
| Rate for Payer: Cash Price |
$2,271.00
|
| Rate for Payer: Cash Price |
$2,271.00
|
| Rate for Payer: Cigna Commercial |
$3,217.25
|
| Rate for Payer: First Health Commercial |
$3,406.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,406.50
|
| Rate for Payer: GEHA Commercial |
$2,649.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,406.50
|
| Rate for Payer: Multiplan All |
$3,444.35
|
| Rate for Payer: OMNI Networks Commercial |
$2,649.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,406.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,595.75
|
| Rate for Payer: Three Rivers Provider Network All |
$2,838.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,520.05
|
| Rate for Payer: Zelis Auto |
$1,514.00
|
|
|
IMPLT MESH COMPOSIX E/X 8X10
|
Facility
|
OP
|
$4,534.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002333
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,133.50 |
| Max. Negotiated Rate |
$4,307.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,720.40
|
| Rate for Payer: Cash Price |
$2,720.40
|
| Rate for Payer: Cash Price |
$2,720.40
|
| Rate for Payer: Cigna Commercial |
$3,853.90
|
| Rate for Payer: First Health Commercial |
$4,080.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,080.60
|
| Rate for Payer: GEHA Commercial |
$3,627.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,080.60
|
| Rate for Payer: Humana ChoiceCare |
$1,178.84
|
| Rate for Payer: Multiplan All |
$4,125.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,720.40
|
| Rate for Payer: OMNI Networks Commercial |
$3,173.80
|
| Rate for Payer: One Health Plan PPO/POS |
$4,080.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,307.30
|
| Rate for Payer: Three Rivers Provider Network All |
$3,400.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,989.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,133.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,216.62
|
| Rate for Payer: Zelis Auto |
$1,813.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,267.00
|
|
|
IMPLT MESH COMPOSIX E/X 8X10
|
Facility
|
IP
|
$4,534.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002333
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,813.60 |
| Max. Negotiated Rate |
$4,307.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,627.20
|
| Rate for Payer: Cash Price |
$2,720.40
|
| Rate for Payer: Cash Price |
$2,720.40
|
| Rate for Payer: Cigna Commercial |
$3,853.90
|
| Rate for Payer: First Health Commercial |
$4,080.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,080.60
|
| Rate for Payer: GEHA Commercial |
$3,173.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,080.60
|
| Rate for Payer: Multiplan All |
$4,125.94
|
| Rate for Payer: OMNI Networks Commercial |
$3,173.80
|
| Rate for Payer: One Health Plan PPO/POS |
$4,080.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,307.30
|
| Rate for Payer: Three Rivers Provider Network All |
$3,400.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,216.62
|
| Rate for Payer: Zelis Auto |
$1,813.60
|
|
|
IMPLT MESH COMPOSIX L/P CIRCLE134450
|
Facility
|
OP
|
$2,466.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002334
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$616.50 |
| Max. Negotiated Rate |
$2,342.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,479.60
|
| Rate for Payer: Cash Price |
$1,479.60
|
| Rate for Payer: Cash Price |
$1,479.60
|
| Rate for Payer: Cigna Commercial |
$2,096.10
|
| Rate for Payer: First Health Commercial |
$2,219.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,219.40
|
| Rate for Payer: GEHA Commercial |
$1,972.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,219.40
|
| Rate for Payer: Humana ChoiceCare |
$641.16
|
| Rate for Payer: Multiplan All |
$2,244.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,479.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,726.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,219.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,342.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,849.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,170.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$616.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,293.38
|
| Rate for Payer: Zelis Auto |
$986.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,233.00
|
|
|
IMPLT MESH COMPOSIX L/P CIRCLE134450
|
Facility
|
IP
|
$2,466.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002334
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$986.40 |
| Max. Negotiated Rate |
$2,342.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,972.80
|
| Rate for Payer: Cash Price |
$1,479.60
|
| Rate for Payer: Cash Price |
$1,479.60
|
| Rate for Payer: Cigna Commercial |
$2,096.10
|
| Rate for Payer: First Health Commercial |
$2,219.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,219.40
|
| Rate for Payer: GEHA Commercial |
$1,726.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,219.40
|
| Rate for Payer: Multiplan All |
$2,244.06
|
| Rate for Payer: OMNI Networks Commercial |
$1,726.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,219.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,342.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,849.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,293.38
|
| Rate for Payer: Zelis Auto |
$986.40
|
|
|
IMPLT MESH COMPOSIX L/P ELLIP 134790
|
Facility
|
IP
|
$3,785.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002335
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,514.00 |
| Max. Negotiated Rate |
$3,595.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,028.00
|
| Rate for Payer: Cash Price |
$2,271.00
|
| Rate for Payer: Cash Price |
$2,271.00
|
| Rate for Payer: Cigna Commercial |
$3,217.25
|
| Rate for Payer: First Health Commercial |
$3,406.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,406.50
|
| Rate for Payer: GEHA Commercial |
$2,649.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,406.50
|
| Rate for Payer: Multiplan All |
$3,444.35
|
| Rate for Payer: OMNI Networks Commercial |
$2,649.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,406.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,595.75
|
| Rate for Payer: Three Rivers Provider Network All |
$2,838.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,520.05
|
| Rate for Payer: Zelis Auto |
$1,514.00
|
|
|
IMPLT MESH COMPOSIX L/P ELLIP 134790
|
Facility
|
OP
|
$3,785.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002335
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$946.25 |
| Max. Negotiated Rate |
$3,595.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,271.00
|
| Rate for Payer: Cash Price |
$2,271.00
|
| Rate for Payer: Cash Price |
$2,271.00
|
| Rate for Payer: Cigna Commercial |
$3,217.25
|
| Rate for Payer: First Health Commercial |
$3,406.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,406.50
|
| Rate for Payer: GEHA Commercial |
$3,028.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,406.50
|
| Rate for Payer: Humana ChoiceCare |
$984.10
|
| Rate for Payer: Multiplan All |
$3,444.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,271.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,649.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,406.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,595.75
|
| Rate for Payer: Three Rivers Provider Network All |
$2,838.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,330.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$946.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,520.05
|
| Rate for Payer: Zelis Auto |
$1,514.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,892.50
|
|
|
IMPLT MESH COMPOSIX L/P ELLIPT134460
|
Facility
|
IP
|
$1,699.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002336
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$679.60 |
| Max. Negotiated Rate |
$1,614.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,359.20
|
| Rate for Payer: Cash Price |
$1,019.40
|
| Rate for Payer: Cash Price |
$1,019.40
|
| Rate for Payer: Cigna Commercial |
$1,444.15
|
| Rate for Payer: First Health Commercial |
$1,529.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,529.10
|
| Rate for Payer: GEHA Commercial |
$1,189.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,529.10
|
| Rate for Payer: Multiplan All |
$1,546.09
|
| Rate for Payer: OMNI Networks Commercial |
$1,189.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,529.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,614.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,274.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,580.07
|
| Rate for Payer: Zelis Auto |
$679.60
|
|
|
IMPLT MESH COMPOSIX L/P ELLIPT134460
|
Facility
|
OP
|
$1,699.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002336
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$424.75 |
| Max. Negotiated Rate |
$1,614.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,019.40
|
| Rate for Payer: Cash Price |
$1,019.40
|
| Rate for Payer: Cash Price |
$1,019.40
|
| Rate for Payer: Cigna Commercial |
$1,444.15
|
| Rate for Payer: First Health Commercial |
$1,529.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,529.10
|
| Rate for Payer: GEHA Commercial |
$1,359.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,529.10
|
| Rate for Payer: Humana ChoiceCare |
$441.74
|
| Rate for Payer: Multiplan All |
$1,546.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,019.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,189.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,529.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,614.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,274.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,495.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$424.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,580.07
|
| Rate for Payer: Zelis Auto |
$679.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$849.50
|
|
