|
IMPLT MESH COMPOSIX L/P ELLIPT134680
|
Facility
|
IP
|
$3,048.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002337
|
|
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 L/P ELLIPT134680
|
Facility
|
OP
|
$3,048.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002337
|
|
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 CURASOFT PATCH LRG 116003
|
Facility
|
IP
|
$2,229.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002338
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$891.60 |
| Max. Negotiated Rate |
$2,117.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,783.20
|
| Rate for Payer: Cash Price |
$1,337.40
|
| Rate for Payer: Cash Price |
$1,337.40
|
| Rate for Payer: Cigna Commercial |
$1,894.65
|
| Rate for Payer: First Health Commercial |
$2,006.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,006.10
|
| Rate for Payer: GEHA Commercial |
$1,560.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,006.10
|
| Rate for Payer: Multiplan All |
$2,028.39
|
| Rate for Payer: OMNI Networks Commercial |
$1,560.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,006.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,117.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,671.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,072.97
|
| Rate for Payer: Zelis Auto |
$891.60
|
|
|
IMPLT MESH CURASOFT PATCH LRG 116003
|
Facility
|
OP
|
$2,229.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002338
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$557.25 |
| Max. Negotiated Rate |
$2,117.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,337.40
|
| Rate for Payer: Cash Price |
$1,337.40
|
| Rate for Payer: Cash Price |
$1,337.40
|
| Rate for Payer: Cigna Commercial |
$1,894.65
|
| Rate for Payer: First Health Commercial |
$2,006.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,006.10
|
| Rate for Payer: GEHA Commercial |
$1,783.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,006.10
|
| Rate for Payer: Humana ChoiceCare |
$579.54
|
| Rate for Payer: Multiplan All |
$2,028.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,337.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,560.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,006.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,117.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,671.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,961.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$557.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,072.97
|
| Rate for Payer: Zelis Auto |
$891.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,114.50
|
|
|
IMPLT MESH DIRECT ANTERIOR
|
Facility
|
OP
|
$5,457.00
|
|
|
Service Code
|
CPT C1771
|
| Hospital Charge Code |
7006624
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,364.25 |
| Max. Negotiated Rate |
$5,184.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,274.20
|
| Rate for Payer: Cash Price |
$3,274.20
|
| Rate for Payer: Cash Price |
$3,274.20
|
| Rate for Payer: Cigna Commercial |
$4,638.45
|
| Rate for Payer: First Health Commercial |
$4,911.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,911.30
|
| Rate for Payer: GEHA Commercial |
$4,365.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,911.30
|
| Rate for Payer: Humana ChoiceCare |
$1,418.82
|
| Rate for Payer: Multiplan All |
$4,965.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,274.20
|
| Rate for Payer: OMNI Networks Commercial |
$3,819.90
|
| Rate for Payer: One Health Plan PPO/POS |
$4,911.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,184.15
|
| Rate for Payer: Three Rivers Provider Network All |
$4,092.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,802.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,364.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,075.01
|
| Rate for Payer: Zelis Auto |
$2,182.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,728.50
|
|
|
IMPLT MESH DIRECT ANTERIOR
|
Facility
|
IP
|
$5,457.00
|
|
|
Service Code
|
CPT C1771
|
| Hospital Charge Code |
7006624
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,182.80 |
| Max. Negotiated Rate |
$5,184.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,365.60
|
| Rate for Payer: Cash Price |
$3,274.20
|
| Rate for Payer: Cash Price |
$3,274.20
|
| Rate for Payer: Cigna Commercial |
$4,638.45
|
| Rate for Payer: First Health Commercial |
$4,911.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,911.30
|
| Rate for Payer: GEHA Commercial |
$3,819.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,911.30
|
| Rate for Payer: Multiplan All |
$4,965.87
|
| Rate for Payer: OMNI Networks Commercial |
$3,819.90
|
| Rate for Payer: One Health Plan PPO/POS |
$4,911.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,184.15
|
| Rate for Payer: Three Rivers Provider Network All |
$4,092.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,075.01
|
| Rate for Payer: Zelis Auto |
$2,182.80
|
|
|
IMPLT MESH EXTRA LARGE PHASIX PLUG
|
Facility
|
IP
|
$2,121.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002339
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$848.40 |
| Max. Negotiated Rate |
$2,014.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,696.80
|
| Rate for Payer: Cash Price |
$1,272.60
|
| Rate for Payer: Cash Price |
$1,272.60
|
| Rate for Payer: Cigna Commercial |
$1,802.85
|
| Rate for Payer: First Health Commercial |
$1,908.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,908.90
|
| Rate for Payer: GEHA Commercial |
$1,484.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,908.90
|
| Rate for Payer: Multiplan All |
$1,930.11
|
| Rate for Payer: OMNI Networks Commercial |
$1,484.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,908.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,014.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,590.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,972.53
|
| Rate for Payer: Zelis Auto |
$848.40
|
|
|
IMPLT MESH EXTRA LARGE PHASIX PLUG
|
Facility
|
OP
|
$2,121.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002339
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$530.25 |
| Max. Negotiated Rate |
$2,014.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,272.60
|
| Rate for Payer: Cash Price |
$1,272.60
|
| Rate for Payer: Cash Price |
$1,272.60
|
| Rate for Payer: Cigna Commercial |
$1,802.85
|
| Rate for Payer: First Health Commercial |
$1,908.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,908.90
|
| Rate for Payer: GEHA Commercial |
$1,696.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,908.90
|
| Rate for Payer: Humana ChoiceCare |
$551.46
|
| Rate for Payer: Multiplan All |
$1,930.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,272.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,484.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,908.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,014.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,590.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,866.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$530.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,972.53
|
| Rate for Payer: Zelis Auto |
$848.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,060.50
|
|
|
IMPLT MESH FLAT 15CM X15CM
|
Facility
|
OP
|
$1,760.92
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7003234
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$440.23 |
| Max. Negotiated Rate |
$1,672.87 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,056.55
|
| Rate for Payer: Cash Price |
$1,056.55
|
| Rate for Payer: Cash Price |
$1,056.55
|
| Rate for Payer: Cigna Commercial |
$1,496.78
|
| Rate for Payer: First Health Commercial |
$1,584.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,584.83
|
| Rate for Payer: GEHA Commercial |
$1,408.74
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,584.83
|
| Rate for Payer: Humana ChoiceCare |
$457.84
|
| Rate for Payer: Multiplan All |
$1,602.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,056.55
|
| Rate for Payer: OMNI Networks Commercial |
$1,232.64
|
| Rate for Payer: One Health Plan PPO/POS |
$1,584.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,672.87
|
| Rate for Payer: Three Rivers Provider Network All |
$1,320.69
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,549.61
|
| Rate for Payer: United Healthcare Managed Medicaid |
$440.23
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,637.66
|
| Rate for Payer: Zelis Auto |
$704.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$880.46
|
|
|
IMPLT MESH FLAT 15CM X15CM
|
Facility
|
IP
|
$1,760.92
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7003234
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$704.37 |
| Max. Negotiated Rate |
$1,672.87 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,408.74
|
| Rate for Payer: Cash Price |
$1,056.55
|
| Rate for Payer: Cash Price |
$1,056.55
|
| Rate for Payer: Cigna Commercial |
$1,496.78
|
| Rate for Payer: First Health Commercial |
$1,584.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,584.83
|
| Rate for Payer: GEHA Commercial |
$1,232.64
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,584.83
|
| Rate for Payer: Multiplan All |
$1,602.44
|
| Rate for Payer: OMNI Networks Commercial |
$1,232.64
|
| Rate for Payer: One Health Plan PPO/POS |
$1,584.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,672.87
|
| Rate for Payer: Three Rivers Provider Network All |
$1,320.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,637.66
|
| Rate for Payer: Zelis Auto |
$704.37
|
|
|
IMPLT MESH FLAT 7.6CM X15CM
|
Facility
|
OP
|
$662.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7003233
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$165.50 |
| Max. Negotiated Rate |
$628.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$397.20
|
| Rate for Payer: Cash Price |
$397.20
|
| Rate for Payer: Cash Price |
$397.20
|
| Rate for Payer: Cigna Commercial |
$562.70
|
| Rate for Payer: First Health Commercial |
$595.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$595.80
|
| Rate for Payer: GEHA Commercial |
$529.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$595.80
|
| Rate for Payer: Humana ChoiceCare |
$172.12
|
| Rate for Payer: Multiplan All |
$602.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$397.20
|
| Rate for Payer: OMNI Networks Commercial |
$463.40
|
| Rate for Payer: One Health Plan PPO/POS |
$595.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$628.90
|
| Rate for Payer: Three Rivers Provider Network All |
$496.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$582.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$165.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$615.66
|
| Rate for Payer: Zelis Auto |
$264.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$331.00
|
|
|
IMPLT MESH FLAT 7.6CM X15CM
|
Facility
|
IP
|
$662.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7003233
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.80 |
| Max. Negotiated Rate |
$628.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$529.60
|
| Rate for Payer: Cash Price |
$397.20
|
| Rate for Payer: Cash Price |
$397.20
|
| Rate for Payer: Cigna Commercial |
$562.70
|
| Rate for Payer: First Health Commercial |
$595.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$595.80
|
| Rate for Payer: GEHA Commercial |
$463.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$595.80
|
| Rate for Payer: Multiplan All |
$602.42
|
| Rate for Payer: OMNI Networks Commercial |
$463.40
|
| Rate for Payer: One Health Plan PPO/POS |
$595.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$628.90
|
| Rate for Payer: Three Rivers Provider Network All |
$496.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$615.66
|
| Rate for Payer: Zelis Auto |
$264.80
|
|
|
IMPLT MESH LARGE PHASIX PLUG
|
Facility
|
OP
|
$2,081.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002380
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$520.25 |
| Max. Negotiated Rate |
$1,976.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,248.60
|
| Rate for Payer: Cash Price |
$1,248.60
|
| Rate for Payer: Cash Price |
$1,248.60
|
| Rate for Payer: Cigna Commercial |
$1,768.85
|
| Rate for Payer: First Health Commercial |
$1,872.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,872.90
|
| Rate for Payer: GEHA Commercial |
$1,664.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,872.90
|
| Rate for Payer: Humana ChoiceCare |
$541.06
|
| Rate for Payer: Multiplan All |
$1,893.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,248.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,456.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,872.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,976.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,560.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,831.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$520.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,935.33
|
| Rate for Payer: Zelis Auto |
$832.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,040.50
|
|
|
IMPLT MESH LARGE PHASIX PLUG
|
Facility
|
IP
|
$2,081.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002380
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$832.40 |
| Max. Negotiated Rate |
$1,976.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,664.80
|
| Rate for Payer: Cash Price |
$1,248.60
|
| Rate for Payer: Cash Price |
$1,248.60
|
| Rate for Payer: Cigna Commercial |
$1,768.85
|
| Rate for Payer: First Health Commercial |
$1,872.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,872.90
|
| Rate for Payer: GEHA Commercial |
$1,456.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,872.90
|
| Rate for Payer: Multiplan All |
$1,893.71
|
| Rate for Payer: OMNI Networks Commercial |
$1,456.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,872.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,976.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,560.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,935.33
|
| Rate for Payer: Zelis Auto |
$832.40
|
|
|
IMPLT MESH MEDIUM PHASIX PLUG
|
Facility
|
IP
|
$2,040.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002340
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$816.00 |
| Max. Negotiated Rate |
$1,938.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,632.00
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cigna Commercial |
$1,734.00
|
| Rate for Payer: First Health Commercial |
$1,836.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,836.00
|
| Rate for Payer: GEHA Commercial |
$1,428.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,836.00
|
| Rate for Payer: Multiplan All |
$1,856.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,428.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,836.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,938.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,530.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,897.20
|
| Rate for Payer: Zelis Auto |
$816.00
|
|
|
IMPLT MESH MEDIUM PHASIX PLUG
|
Facility
|
OP
|
$2,040.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002340
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$510.00 |
| Max. Negotiated Rate |
$1,938.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,224.00
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cigna Commercial |
$1,734.00
|
| Rate for Payer: First Health Commercial |
$1,836.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,836.00
|
| Rate for Payer: GEHA Commercial |
$1,632.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,836.00
|
| Rate for Payer: Humana ChoiceCare |
$530.40
|
| Rate for Payer: Multiplan All |
$1,856.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,224.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,428.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,836.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,938.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,530.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,795.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$510.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,897.20
|
| Rate for Payer: Zelis Auto |
$816.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,020.00
|
|
|
IMPLT MESH MOSAIC 10CMX15CM
|
Facility
|
OP
|
$1,664.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002985
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$416.00 |
| Max. Negotiated Rate |
$1,580.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$998.40
|
| Rate for Payer: Cash Price |
$998.40
|
| Rate for Payer: Cash Price |
$998.40
|
| Rate for Payer: Cigna Commercial |
$1,414.40
|
| Rate for Payer: First Health Commercial |
$1,497.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,497.60
|
| Rate for Payer: GEHA Commercial |
$1,331.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,497.60
|
| Rate for Payer: Humana ChoiceCare |
$432.64
|
| Rate for Payer: Multiplan All |
$1,514.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$998.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,164.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,497.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,580.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,248.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,464.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$416.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,547.52
|
| Rate for Payer: Zelis Auto |
$665.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$832.00
|
|
|
IMPLT MESH MOSAIC 10CMX15CM
|
Facility
|
IP
|
$1,664.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002985
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$665.60 |
| Max. Negotiated Rate |
$1,580.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,331.20
|
| Rate for Payer: Cash Price |
$998.40
|
| Rate for Payer: Cash Price |
$998.40
|
| Rate for Payer: Cigna Commercial |
$1,414.40
|
| Rate for Payer: First Health Commercial |
$1,497.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,497.60
|
| Rate for Payer: GEHA Commercial |
$1,164.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,497.60
|
| Rate for Payer: Multiplan All |
$1,514.24
|
| Rate for Payer: OMNI Networks Commercial |
$1,164.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,497.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,580.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,248.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,547.52
|
| Rate for Payer: Zelis Auto |
$665.60
|
|
|
IMPLT MESH MOSAIC 15CMX15CM
|
Facility
|
OP
|
$2,396.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002984
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.00 |
| Max. Negotiated Rate |
$2,276.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,437.60
|
| Rate for Payer: Cash Price |
$1,437.60
|
| Rate for Payer: Cash Price |
$1,437.60
|
| Rate for Payer: Cigna Commercial |
$2,036.60
|
| Rate for Payer: First Health Commercial |
$2,156.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,156.40
|
| Rate for Payer: GEHA Commercial |
$1,916.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,156.40
|
| Rate for Payer: Humana ChoiceCare |
$622.96
|
| Rate for Payer: Multiplan All |
$2,180.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,437.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,677.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,156.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,276.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,797.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,108.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$599.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,228.28
|
| Rate for Payer: Zelis Auto |
$958.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,198.00
|
|
|
IMPLT MESH MOSAIC 15CMX15CM
|
Facility
|
IP
|
$2,396.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002984
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$958.40 |
| Max. Negotiated Rate |
$2,276.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,916.80
|
| Rate for Payer: Cash Price |
$1,437.60
|
| Rate for Payer: Cash Price |
$1,437.60
|
| Rate for Payer: Cigna Commercial |
$2,036.60
|
| Rate for Payer: First Health Commercial |
$2,156.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,156.40
|
| Rate for Payer: GEHA Commercial |
$1,677.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,156.40
|
| Rate for Payer: Multiplan All |
$2,180.36
|
| Rate for Payer: OMNI Networks Commercial |
$1,677.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,156.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,276.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,797.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,228.28
|
| Rate for Payer: Zelis Auto |
$958.40
|
|
|
IMPLT MESH MOSAIC 9CM X 9CM
|
Facility
|
IP
|
$1,385.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7006362
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$554.00 |
| Max. Negotiated Rate |
$1,315.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,108.00
|
| Rate for Payer: Cash Price |
$831.00
|
| Rate for Payer: Cash Price |
$831.00
|
| Rate for Payer: Cigna Commercial |
$1,177.25
|
| Rate for Payer: First Health Commercial |
$1,246.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,246.50
|
| Rate for Payer: GEHA Commercial |
$969.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,246.50
|
| Rate for Payer: Multiplan All |
$1,260.35
|
| Rate for Payer: OMNI Networks Commercial |
$969.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,246.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,315.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,038.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,288.05
|
| Rate for Payer: Zelis Auto |
$554.00
|
|
|
IMPLT MESH MOSAIC 9CM X 9CM
|
Facility
|
OP
|
$1,385.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7006362
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$346.25 |
| Max. Negotiated Rate |
$1,315.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$831.00
|
| Rate for Payer: Cash Price |
$831.00
|
| Rate for Payer: Cash Price |
$831.00
|
| Rate for Payer: Cigna Commercial |
$1,177.25
|
| Rate for Payer: First Health Commercial |
$1,246.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,246.50
|
| Rate for Payer: GEHA Commercial |
$1,108.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,246.50
|
| Rate for Payer: Humana ChoiceCare |
$360.10
|
| Rate for Payer: Multiplan All |
$1,260.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$831.00
|
| Rate for Payer: OMNI Networks Commercial |
$969.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,246.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,315.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,038.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,218.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$346.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,288.05
|
| Rate for Payer: Zelis Auto |
$554.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$692.50
|
|
|
IMPLT MESH OVAL 4X6
|
Facility
|
OP
|
$2,150.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002911
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$537.50 |
| Max. Negotiated Rate |
$2,042.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,290.00
|
| Rate for Payer: Cash Price |
$1,290.00
|
| Rate for Payer: Cash Price |
$1,290.00
|
| Rate for Payer: Cigna Commercial |
$1,827.50
|
| Rate for Payer: First Health Commercial |
$1,935.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,935.00
|
| Rate for Payer: GEHA Commercial |
$1,720.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,935.00
|
| Rate for Payer: Humana ChoiceCare |
$559.00
|
| Rate for Payer: Multiplan All |
$1,956.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,290.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,505.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,935.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,042.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,612.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,892.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$537.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,999.50
|
| Rate for Payer: Zelis Auto |
$860.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,075.00
|
|
|
IMPLT MESH OVAL 4X6
|
Facility
|
IP
|
$2,150.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002911
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$860.00 |
| Max. Negotiated Rate |
$2,042.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,720.00
|
| Rate for Payer: Cash Price |
$1,290.00
|
| Rate for Payer: Cash Price |
$1,290.00
|
| Rate for Payer: Cigna Commercial |
$1,827.50
|
| Rate for Payer: First Health Commercial |
$1,935.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,935.00
|
| Rate for Payer: GEHA Commercial |
$1,505.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,935.00
|
| Rate for Payer: Multiplan All |
$1,956.50
|
| Rate for Payer: OMNI Networks Commercial |
$1,505.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,935.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,042.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,612.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,999.50
|
| Rate for Payer: Zelis Auto |
$860.00
|
|
|
IMPLT MESH OVAL 6X8
|
Facility
|
IP
|
$4,295.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002910
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,718.00 |
| Max. Negotiated Rate |
$4,080.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,436.00
|
| Rate for Payer: Cash Price |
$2,577.00
|
| Rate for Payer: Cash Price |
$2,577.00
|
| Rate for Payer: Cigna Commercial |
$3,650.75
|
| Rate for Payer: First Health Commercial |
$3,865.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,865.50
|
| Rate for Payer: GEHA Commercial |
$3,006.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,865.50
|
| Rate for Payer: Multiplan All |
$3,908.45
|
| Rate for Payer: OMNI Networks Commercial |
$3,006.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,865.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,080.25
|
| Rate for Payer: Three Rivers Provider Network All |
$3,221.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,994.35
|
| Rate for Payer: Zelis Auto |
$1,718.00
|
|
