|
IMPLT MESH VENTRALEX MEDIUM 0010302
|
Facility
|
IP
|
$2,866.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002353
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,146.40 |
| Max. Negotiated Rate |
$2,722.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,292.80
|
| Rate for Payer: Cash Price |
$1,719.60
|
| Rate for Payer: Cash Price |
$1,719.60
|
| Rate for Payer: Cigna Commercial |
$2,436.10
|
| Rate for Payer: First Health Commercial |
$2,579.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,579.40
|
| Rate for Payer: GEHA Commercial |
$2,006.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,579.40
|
| Rate for Payer: Multiplan All |
$2,608.06
|
| Rate for Payer: OMNI Networks Commercial |
$2,006.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,579.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,722.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,149.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,665.38
|
| Rate for Payer: Zelis Auto |
$1,146.40
|
|
|
IMPLT MESH VENTRALEX SMALL 10301
|
Facility
|
IP
|
$1,768.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002354
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$707.20 |
| Max. Negotiated Rate |
$1,679.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,414.40
|
| Rate for Payer: Cash Price |
$1,060.80
|
| Rate for Payer: Cash Price |
$1,060.80
|
| Rate for Payer: Cigna Commercial |
$1,502.80
|
| Rate for Payer: First Health Commercial |
$1,591.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,591.20
|
| Rate for Payer: GEHA Commercial |
$1,237.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,591.20
|
| Rate for Payer: Multiplan All |
$1,608.88
|
| Rate for Payer: OMNI Networks Commercial |
$1,237.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,591.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,679.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,326.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,644.24
|
| Rate for Payer: Zelis Auto |
$707.20
|
|
|
IMPLT MESH VENTRALEX SMALL 10301
|
Facility
|
OP
|
$1,768.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002354
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$442.00 |
| Max. Negotiated Rate |
$1,679.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,060.80
|
| Rate for Payer: Cash Price |
$1,060.80
|
| Rate for Payer: Cash Price |
$1,060.80
|
| Rate for Payer: Cigna Commercial |
$1,502.80
|
| Rate for Payer: First Health Commercial |
$1,591.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,591.20
|
| Rate for Payer: GEHA Commercial |
$1,414.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,591.20
|
| Rate for Payer: Humana ChoiceCare |
$459.68
|
| Rate for Payer: Multiplan All |
$1,608.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,060.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,237.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,591.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,679.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,326.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,555.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$442.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,644.24
|
| Rate for Payer: Zelis Auto |
$707.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$884.00
|
|
|
IMPLT MESH VENTRALEX ST 6.4CM CIRCLE
|
Facility
|
IP
|
$3,217.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002355
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,286.80 |
| Max. Negotiated Rate |
$3,056.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,573.60
|
| Rate for Payer: Cash Price |
$1,930.20
|
| Rate for Payer: Cash Price |
$1,930.20
|
| Rate for Payer: Cigna Commercial |
$2,734.45
|
| Rate for Payer: First Health Commercial |
$2,895.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,895.30
|
| Rate for Payer: GEHA Commercial |
$2,251.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,895.30
|
| Rate for Payer: Multiplan All |
$2,927.47
|
| Rate for Payer: OMNI Networks Commercial |
$2,251.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,895.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,056.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,412.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,991.81
|
| Rate for Payer: Zelis Auto |
$1,286.80
|
|
|
IMPLT MESH VENTRALEX ST 6.4CM CIRCLE
|
Facility
|
OP
|
$3,217.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002355
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$804.25 |
| Max. Negotiated Rate |
$3,056.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,930.20
|
| Rate for Payer: Cash Price |
$1,930.20
|
| Rate for Payer: Cash Price |
$1,930.20
|
| Rate for Payer: Cigna Commercial |
$2,734.45
|
| Rate for Payer: First Health Commercial |
$2,895.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,895.30
|
| Rate for Payer: GEHA Commercial |
$2,573.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,895.30
|
| Rate for Payer: Humana ChoiceCare |
$836.42
|
| Rate for Payer: Multiplan All |
$2,927.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,930.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,251.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,895.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,056.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,412.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,830.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$804.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,991.81
|
| Rate for Payer: Zelis Auto |
$1,286.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,608.50
|
|
|
IMPLT MESH VENTRALEX ST LARGE 8CM
|
Facility
|
IP
|
$2,647.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002367
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,058.80 |
| Max. Negotiated Rate |
$2,514.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,117.60
|
| Rate for Payer: Cash Price |
$1,588.20
|
| Rate for Payer: Cash Price |
$1,588.20
|
| Rate for Payer: Cigna Commercial |
$2,249.95
|
| Rate for Payer: First Health Commercial |
$2,382.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,382.30
|
| Rate for Payer: GEHA Commercial |
$1,852.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,382.30
|
| Rate for Payer: Multiplan All |
$2,408.77
|
| Rate for Payer: OMNI Networks Commercial |
$1,852.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,382.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,514.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,985.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,461.71
|
| Rate for Payer: Zelis Auto |
$1,058.80
|
|
|
IMPLT MESH VENTRALEX ST LARGE 8CM
|
Facility
|
OP
|
$2,647.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002367
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$661.75 |
| Max. Negotiated Rate |
$2,514.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,588.20
|
| Rate for Payer: Cash Price |
$1,588.20
|
| Rate for Payer: Cash Price |
$1,588.20
|
| Rate for Payer: Cigna Commercial |
$2,249.95
|
| Rate for Payer: First Health Commercial |
$2,382.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,382.30
|
| Rate for Payer: GEHA Commercial |
$2,117.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,382.30
|
| Rate for Payer: Humana ChoiceCare |
$688.22
|
| Rate for Payer: Multiplan All |
$2,408.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,588.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,852.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,382.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,514.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,985.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,329.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$661.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,461.71
|
| Rate for Payer: Zelis Auto |
$1,058.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,323.50
|
|
|
IMPLT MESH VENTRALEX ST SMALL 4.3CM
|
Facility
|
OP
|
$2,627.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002368
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$656.75 |
| Max. Negotiated Rate |
$2,495.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,576.20
|
| Rate for Payer: Cash Price |
$1,576.20
|
| Rate for Payer: Cash Price |
$1,576.20
|
| Rate for Payer: Cigna Commercial |
$2,232.95
|
| Rate for Payer: First Health Commercial |
$2,364.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,364.30
|
| Rate for Payer: GEHA Commercial |
$2,101.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,364.30
|
| Rate for Payer: Humana ChoiceCare |
$683.02
|
| Rate for Payer: Multiplan All |
$2,390.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,576.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,838.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,364.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,495.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,970.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,311.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$656.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,443.11
|
| Rate for Payer: Zelis Auto |
$1,050.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,313.50
|
|
|
IMPLT MESH VENTRALEX ST SMALL 4.3CM
|
Facility
|
IP
|
$2,627.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002368
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,050.80 |
| Max. Negotiated Rate |
$2,495.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,101.60
|
| Rate for Payer: Cash Price |
$1,576.20
|
| Rate for Payer: Cash Price |
$1,576.20
|
| Rate for Payer: Cigna Commercial |
$2,232.95
|
| Rate for Payer: First Health Commercial |
$2,364.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,364.30
|
| Rate for Payer: GEHA Commercial |
$1,838.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,364.30
|
| Rate for Payer: Multiplan All |
$2,390.57
|
| Rate for Payer: OMNI Networks Commercial |
$1,838.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,364.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,495.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,970.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,443.11
|
| Rate for Payer: Zelis Auto |
$1,050.80
|
|
|
IMPLT MESH VENTRALIGHT 20.3X25.4 CM
|
Facility
|
OP
|
$4,820.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002356
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,205.00 |
| Max. Negotiated Rate |
$4,579.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,892.00
|
| Rate for Payer: Cash Price |
$2,892.00
|
| Rate for Payer: Cash Price |
$2,892.00
|
| Rate for Payer: Cigna Commercial |
$4,097.00
|
| Rate for Payer: First Health Commercial |
$4,338.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,338.00
|
| Rate for Payer: GEHA Commercial |
$3,856.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,338.00
|
| Rate for Payer: Humana ChoiceCare |
$1,253.20
|
| Rate for Payer: Multiplan All |
$4,386.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,892.00
|
| Rate for Payer: OMNI Networks Commercial |
$3,374.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,338.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,579.00
|
| Rate for Payer: Three Rivers Provider Network All |
$3,615.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,241.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,205.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,482.60
|
| Rate for Payer: Zelis Auto |
$1,928.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,410.00
|
|
|
IMPLT MESH VENTRALIGHT 20.3X25.4 CM
|
Facility
|
IP
|
$4,820.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002356
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,928.00 |
| Max. Negotiated Rate |
$4,579.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,856.00
|
| Rate for Payer: Cash Price |
$2,892.00
|
| Rate for Payer: Cash Price |
$2,892.00
|
| Rate for Payer: Cigna Commercial |
$4,097.00
|
| Rate for Payer: First Health Commercial |
$4,338.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,338.00
|
| Rate for Payer: GEHA Commercial |
$3,374.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,338.00
|
| Rate for Payer: Multiplan All |
$4,386.20
|
| Rate for Payer: OMNI Networks Commercial |
$3,374.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,338.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,579.00
|
| Rate for Payer: Three Rivers Provider Network All |
$3,615.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,482.60
|
| Rate for Payer: Zelis Auto |
$1,928.00
|
|
|
IMPLT MESH VENTRALIGHT ECHO 15X25CM
|
Facility
|
IP
|
$6,395.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7003235
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,558.00 |
| Max. Negotiated Rate |
$6,075.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,116.00
|
| Rate for Payer: Cash Price |
$3,837.00
|
| Rate for Payer: Cash Price |
$3,837.00
|
| Rate for Payer: Cigna Commercial |
$5,435.75
|
| Rate for Payer: First Health Commercial |
$5,755.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,755.50
|
| Rate for Payer: GEHA Commercial |
$4,476.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,755.50
|
| Rate for Payer: Multiplan All |
$5,819.45
|
| Rate for Payer: OMNI Networks Commercial |
$4,476.50
|
| Rate for Payer: One Health Plan PPO/POS |
$5,755.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,075.25
|
| Rate for Payer: Three Rivers Provider Network All |
$4,796.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,947.35
|
| Rate for Payer: Zelis Auto |
$2,558.00
|
|
|
IMPLT MESH VENTRALIGHT ECHO 15X25CM
|
Facility
|
OP
|
$6,395.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7003235
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,598.75 |
| Max. Negotiated Rate |
$6,075.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,837.00
|
| Rate for Payer: Cash Price |
$3,837.00
|
| Rate for Payer: Cash Price |
$3,837.00
|
| Rate for Payer: Cigna Commercial |
$5,435.75
|
| Rate for Payer: First Health Commercial |
$5,755.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,755.50
|
| Rate for Payer: GEHA Commercial |
$5,116.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,755.50
|
| Rate for Payer: Humana ChoiceCare |
$1,662.70
|
| Rate for Payer: Multiplan All |
$5,819.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,837.00
|
| Rate for Payer: OMNI Networks Commercial |
$4,476.50
|
| Rate for Payer: One Health Plan PPO/POS |
$5,755.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,075.25
|
| Rate for Payer: Three Rivers Provider Network All |
$4,796.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,627.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,598.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,947.35
|
| Rate for Payer: Zelis Auto |
$2,558.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,197.50
|
|
|
IMPLT MESH VENTRALIGHT ECHO 25X33CM
|
Facility
|
OP
|
$11,495.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7003236
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,873.75 |
| Max. Negotiated Rate |
$10,920.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,897.00
|
| Rate for Payer: Cash Price |
$6,897.00
|
| Rate for Payer: Cash Price |
$6,897.00
|
| Rate for Payer: Cigna Commercial |
$9,770.75
|
| Rate for Payer: First Health Commercial |
$10,345.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10,345.50
|
| Rate for Payer: GEHA Commercial |
$9,196.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10,345.50
|
| Rate for Payer: Humana ChoiceCare |
$2,988.70
|
| Rate for Payer: Multiplan All |
$10,460.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6,897.00
|
| Rate for Payer: OMNI Networks Commercial |
$8,046.50
|
| Rate for Payer: One Health Plan PPO/POS |
$10,345.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10,920.25
|
| Rate for Payer: Three Rivers Provider Network All |
$8,621.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10,115.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,873.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$10,690.35
|
| Rate for Payer: Zelis Auto |
$4,598.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,747.50
|
|
|
IMPLT MESH VENTRALIGHT ECHO 25X33CM
|
Facility
|
IP
|
$11,495.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7003236
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,598.00 |
| Max. Negotiated Rate |
$10,920.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9,196.00
|
| Rate for Payer: Cash Price |
$6,897.00
|
| Rate for Payer: Cash Price |
$6,897.00
|
| Rate for Payer: Cigna Commercial |
$9,770.75
|
| Rate for Payer: First Health Commercial |
$10,345.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10,345.50
|
| Rate for Payer: GEHA Commercial |
$8,046.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10,345.50
|
| Rate for Payer: Multiplan All |
$10,460.45
|
| Rate for Payer: OMNI Networks Commercial |
$8,046.50
|
| Rate for Payer: One Health Plan PPO/POS |
$10,345.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10,920.25
|
| Rate for Payer: Three Rivers Provider Network All |
$8,621.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$10,690.35
|
| Rate for Payer: Zelis Auto |
$4,598.00
|
|
|
IMPLT MESH VENTRALIGHT OVAL 10.2X 15.2CM
|
Facility
|
OP
|
$1,803.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002357
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$450.75 |
| Max. Negotiated Rate |
$1,712.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,081.80
|
| Rate for Payer: Cash Price |
$1,081.80
|
| Rate for Payer: Cash Price |
$1,081.80
|
| Rate for Payer: Cigna Commercial |
$1,532.55
|
| Rate for Payer: First Health Commercial |
$1,622.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,622.70
|
| Rate for Payer: GEHA Commercial |
$1,442.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,622.70
|
| Rate for Payer: Humana ChoiceCare |
$468.78
|
| Rate for Payer: Multiplan All |
$1,640.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,081.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,262.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,622.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,712.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,352.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,586.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$450.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,676.79
|
| Rate for Payer: Zelis Auto |
$721.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$901.50
|
|
|
IMPLT MESH VENTRALIGHT OVAL 10.2X 15.2CM
|
Facility
|
IP
|
$1,803.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002357
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$721.20 |
| Max. Negotiated Rate |
$1,712.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,442.40
|
| Rate for Payer: Cash Price |
$1,081.80
|
| Rate for Payer: Cash Price |
$1,081.80
|
| Rate for Payer: Cigna Commercial |
$1,532.55
|
| Rate for Payer: First Health Commercial |
$1,622.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,622.70
|
| Rate for Payer: GEHA Commercial |
$1,262.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,622.70
|
| Rate for Payer: Multiplan All |
$1,640.73
|
| Rate for Payer: OMNI Networks Commercial |
$1,262.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,622.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,712.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,352.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,676.79
|
| Rate for Payer: Zelis Auto |
$721.20
|
|
|
IMPLT MESH VENTRALIGHT OVAL 6X8"
|
Facility
|
OP
|
$4,263.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002373
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,065.75 |
| Max. Negotiated Rate |
$4,049.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,557.80
|
| Rate for Payer: Cash Price |
$2,557.80
|
| Rate for Payer: Cash Price |
$2,557.80
|
| Rate for Payer: Cigna Commercial |
$3,623.55
|
| Rate for Payer: First Health Commercial |
$3,836.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,836.70
|
| Rate for Payer: GEHA Commercial |
$3,410.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,836.70
|
| Rate for Payer: Humana ChoiceCare |
$1,108.38
|
| Rate for Payer: Multiplan All |
$3,879.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,557.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,984.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,836.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,049.85
|
| Rate for Payer: Three Rivers Provider Network All |
$3,197.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,751.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,065.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,964.59
|
| Rate for Payer: Zelis Auto |
$1,705.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,131.50
|
|
|
IMPLT MESH VENTRALIGHT OVAL 6X8"
|
Facility
|
IP
|
$4,263.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002373
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,705.20 |
| Max. Negotiated Rate |
$4,049.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,410.40
|
| Rate for Payer: Cash Price |
$2,557.80
|
| Rate for Payer: Cash Price |
$2,557.80
|
| Rate for Payer: Cigna Commercial |
$3,623.55
|
| Rate for Payer: First Health Commercial |
$3,836.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,836.70
|
| Rate for Payer: GEHA Commercial |
$2,984.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,836.70
|
| Rate for Payer: Multiplan All |
$3,879.33
|
| Rate for Payer: OMNI Networks Commercial |
$2,984.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,836.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,049.85
|
| Rate for Payer: Three Rivers Provider Network All |
$3,197.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,964.59
|
| Rate for Payer: Zelis Auto |
$1,705.20
|
|
|
IMPLT MESH VENTRALIGHT ST
|
Facility
|
OP
|
$9,120.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7006740
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,280.00 |
| Max. Negotiated Rate |
$8,664.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,472.00
|
| Rate for Payer: Cash Price |
$5,472.00
|
| Rate for Payer: Cash Price |
$5,472.00
|
| Rate for Payer: Cigna Commercial |
$7,752.00
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,208.00
|
| Rate for Payer: GEHA Commercial |
$7,296.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,208.00
|
| Rate for Payer: Humana ChoiceCare |
$2,371.20
|
| Rate for Payer: Multiplan All |
$8,299.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,472.00
|
| Rate for Payer: OMNI Networks Commercial |
$6,384.00
|
| Rate for Payer: One Health Plan PPO/POS |
$8,208.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,664.00
|
| Rate for Payer: Three Rivers Provider Network All |
$6,840.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8,025.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,280.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,481.60
|
| Rate for Payer: Zelis Auto |
$3,648.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,560.00
|
|
|
IMPLT MESH VENTRALIGHT ST
|
Facility
|
OP
|
$17,070.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7006803
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,267.50 |
| Max. Negotiated Rate |
$16,216.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$10,242.00
|
| Rate for Payer: Cash Price |
$10,242.00
|
| Rate for Payer: Cash Price |
$10,242.00
|
| Rate for Payer: Cigna Commercial |
$14,509.50
|
| Rate for Payer: First Health Commercial |
$15,363.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$15,363.00
|
| Rate for Payer: GEHA Commercial |
$13,656.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$15,363.00
|
| Rate for Payer: Humana ChoiceCare |
$4,438.20
|
| Rate for Payer: Multiplan All |
$15,533.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10,242.00
|
| Rate for Payer: OMNI Networks Commercial |
$11,949.00
|
| Rate for Payer: One Health Plan PPO/POS |
$15,363.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$16,216.50
|
| Rate for Payer: Three Rivers Provider Network All |
$12,802.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$15,021.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,267.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$15,875.10
|
| Rate for Payer: Zelis Auto |
$6,828.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,535.00
|
|
|
IMPLT MESH VENTRALIGHT ST
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7006740
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,648.00 |
| Max. Negotiated Rate |
$8,664.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7,296.00
|
| Rate for Payer: Cash Price |
$5,472.00
|
| Rate for Payer: Cash Price |
$5,472.00
|
| Rate for Payer: Cigna Commercial |
$7,752.00
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,208.00
|
| Rate for Payer: GEHA Commercial |
$6,384.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,208.00
|
| Rate for Payer: Multiplan All |
$8,299.20
|
| Rate for Payer: OMNI Networks Commercial |
$6,384.00
|
| Rate for Payer: One Health Plan PPO/POS |
$8,208.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,664.00
|
| Rate for Payer: Three Rivers Provider Network All |
$6,840.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,481.60
|
| Rate for Payer: Zelis Auto |
$3,648.00
|
|
|
IMPLT MESH VENTRALIGHT ST
|
Facility
|
OP
|
$6,108.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7006739
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,527.00 |
| Max. Negotiated Rate |
$5,802.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,664.80
|
| Rate for Payer: Cash Price |
$3,664.80
|
| Rate for Payer: Cash Price |
$3,664.80
|
| Rate for Payer: Cigna Commercial |
$5,191.80
|
| Rate for Payer: First Health Commercial |
$5,497.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,497.20
|
| Rate for Payer: GEHA Commercial |
$4,886.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,497.20
|
| Rate for Payer: Humana ChoiceCare |
$1,588.08
|
| Rate for Payer: Multiplan All |
$5,558.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,664.80
|
| Rate for Payer: OMNI Networks Commercial |
$4,275.60
|
| Rate for Payer: One Health Plan PPO/POS |
$5,497.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,802.60
|
| Rate for Payer: Three Rivers Provider Network All |
$4,581.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,375.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,527.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,680.44
|
| Rate for Payer: Zelis Auto |
$2,443.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,054.00
|
|
|
IMPLT MESH VENTRALIGHT ST
|
Facility
|
IP
|
$6,108.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7006739
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,443.20 |
| Max. Negotiated Rate |
$5,802.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,886.40
|
| Rate for Payer: Cash Price |
$3,664.80
|
| Rate for Payer: Cash Price |
$3,664.80
|
| Rate for Payer: Cigna Commercial |
$5,191.80
|
| Rate for Payer: First Health Commercial |
$5,497.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,497.20
|
| Rate for Payer: GEHA Commercial |
$4,275.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,497.20
|
| Rate for Payer: Multiplan All |
$5,558.28
|
| Rate for Payer: OMNI Networks Commercial |
$4,275.60
|
| Rate for Payer: One Health Plan PPO/POS |
$5,497.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,802.60
|
| Rate for Payer: Three Rivers Provider Network All |
$4,581.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,680.44
|
| Rate for Payer: Zelis Auto |
$2,443.20
|
|
|
IMPLT MESH VENTRALIGHT ST
|
Facility
|
IP
|
$17,070.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7006803
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,828.00 |
| Max. Negotiated Rate |
$16,216.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$13,656.00
|
| Rate for Payer: Cash Price |
$10,242.00
|
| Rate for Payer: Cash Price |
$10,242.00
|
| Rate for Payer: Cigna Commercial |
$14,509.50
|
| Rate for Payer: First Health Commercial |
$15,363.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$15,363.00
|
| Rate for Payer: GEHA Commercial |
$11,949.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$15,363.00
|
| Rate for Payer: Multiplan All |
$15,533.70
|
| Rate for Payer: OMNI Networks Commercial |
$11,949.00
|
| Rate for Payer: One Health Plan PPO/POS |
$15,363.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$16,216.50
|
| Rate for Payer: Three Rivers Provider Network All |
$12,802.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$15,875.10
|
| Rate for Payer: Zelis Auto |
$6,828.00
|
|
