|
IMPLT MESH VENTRALIGHT ST 11.4CM
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002371
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$800.00 |
| Max. Negotiated Rate |
$1,900.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,600.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cigna Commercial |
$1,700.00
|
| Rate for Payer: First Health Commercial |
$1,800.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,800.00
|
| Rate for Payer: GEHA Commercial |
$1,400.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,800.00
|
| Rate for Payer: Multiplan All |
$1,820.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,400.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,800.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,900.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,500.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,860.00
|
| Rate for Payer: Zelis Auto |
$800.00
|
|
|
IMPLT MESH VENTRALIGHT ST 11.4CM
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002371
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$500.00 |
| Max. Negotiated Rate |
$1,900.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,200.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cigna Commercial |
$1,700.00
|
| Rate for Payer: First Health Commercial |
$1,800.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,800.00
|
| Rate for Payer: GEHA Commercial |
$1,600.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,800.00
|
| Rate for Payer: Humana ChoiceCare |
$520.00
|
| Rate for Payer: Multiplan All |
$1,820.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,200.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,400.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,800.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,900.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,500.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,760.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$500.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,860.00
|
| Rate for Payer: Zelis Auto |
$800.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,000.00
|
|
|
IMPLT MESH VENTRALIGHT ST 15.2CM
|
Facility
|
IP
|
$3,806.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002372
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,522.40 |
| Max. Negotiated Rate |
$3,615.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,044.80
|
| Rate for Payer: Cash Price |
$2,283.60
|
| Rate for Payer: Cash Price |
$2,283.60
|
| Rate for Payer: Cigna Commercial |
$3,235.10
|
| Rate for Payer: First Health Commercial |
$3,425.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,425.40
|
| Rate for Payer: GEHA Commercial |
$2,664.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,425.40
|
| Rate for Payer: Multiplan All |
$3,463.46
|
| Rate for Payer: OMNI Networks Commercial |
$2,664.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,425.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,615.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,854.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,539.58
|
| Rate for Payer: Zelis Auto |
$1,522.40
|
|
|
IMPLT MESH VENTRALIGHT ST 15.2CM
|
Facility
|
OP
|
$3,806.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002372
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$951.50 |
| Max. Negotiated Rate |
$3,615.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,283.60
|
| Rate for Payer: Cash Price |
$2,283.60
|
| Rate for Payer: Cash Price |
$2,283.60
|
| Rate for Payer: Cigna Commercial |
$3,235.10
|
| Rate for Payer: First Health Commercial |
$3,425.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,425.40
|
| Rate for Payer: GEHA Commercial |
$3,044.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,425.40
|
| Rate for Payer: Humana ChoiceCare |
$989.56
|
| Rate for Payer: Multiplan All |
$3,463.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,283.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,664.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,425.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,615.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,854.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,349.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$951.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,539.58
|
| Rate for Payer: Zelis Auto |
$1,522.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,903.00
|
|
|
IMPLT MESH VENTRALIGHT ST 17.8 X 22.9CM
|
Facility
|
OP
|
$4,018.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002369
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,004.50 |
| Max. Negotiated Rate |
$3,817.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,410.80
|
| Rate for Payer: Cash Price |
$2,410.80
|
| Rate for Payer: Cash Price |
$2,410.80
|
| Rate for Payer: Cigna Commercial |
$3,415.30
|
| Rate for Payer: First Health Commercial |
$3,616.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,616.20
|
| Rate for Payer: GEHA Commercial |
$3,214.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,616.20
|
| Rate for Payer: Humana ChoiceCare |
$1,044.68
|
| Rate for Payer: Multiplan All |
$3,656.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,410.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,812.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,616.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,817.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,013.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,535.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,004.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,736.74
|
| Rate for Payer: Zelis Auto |
$1,607.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,009.00
|
|
|
IMPLT MESH VENTRALIGHT ST 17.8 X 22.9CM
|
Facility
|
IP
|
$4,018.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002369
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,607.20 |
| Max. Negotiated Rate |
$3,817.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,214.40
|
| Rate for Payer: Cash Price |
$2,410.80
|
| Rate for Payer: Cash Price |
$2,410.80
|
| Rate for Payer: Cigna Commercial |
$3,415.30
|
| Rate for Payer: First Health Commercial |
$3,616.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,616.20
|
| Rate for Payer: GEHA Commercial |
$2,812.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,616.20
|
| Rate for Payer: Multiplan All |
$3,656.38
|
| Rate for Payer: OMNI Networks Commercial |
$2,812.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,616.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,817.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,013.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,736.74
|
| Rate for Payer: Zelis Auto |
$1,607.20
|
|
|
IMPLT MESH VENTRALIGHT ST 4.5
|
Facility
|
IP
|
$4,537.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7006742
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,814.80 |
| Max. Negotiated Rate |
$4,310.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,629.60
|
| Rate for Payer: Cash Price |
$2,722.20
|
| Rate for Payer: Cash Price |
$2,722.20
|
| Rate for Payer: Cigna Commercial |
$3,856.45
|
| Rate for Payer: First Health Commercial |
$4,083.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,083.30
|
| Rate for Payer: GEHA Commercial |
$3,175.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,083.30
|
| Rate for Payer: Multiplan All |
$4,128.67
|
| Rate for Payer: OMNI Networks Commercial |
$3,175.90
|
| Rate for Payer: One Health Plan PPO/POS |
$4,083.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,310.15
|
| Rate for Payer: Three Rivers Provider Network All |
$3,402.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,219.41
|
| Rate for Payer: Zelis Auto |
$1,814.80
|
|
|
IMPLT MESH VENTRALIGHT ST 4.5
|
Facility
|
OP
|
$4,537.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7006742
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,134.25 |
| Max. Negotiated Rate |
$4,310.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,722.20
|
| Rate for Payer: Cash Price |
$2,722.20
|
| Rate for Payer: Cash Price |
$2,722.20
|
| Rate for Payer: Cigna Commercial |
$3,856.45
|
| Rate for Payer: First Health Commercial |
$4,083.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,083.30
|
| Rate for Payer: GEHA Commercial |
$3,629.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,083.30
|
| Rate for Payer: Humana ChoiceCare |
$1,179.62
|
| Rate for Payer: Multiplan All |
$4,128.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,722.20
|
| Rate for Payer: OMNI Networks Commercial |
$3,175.90
|
| Rate for Payer: One Health Plan PPO/POS |
$4,083.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,310.15
|
| Rate for Payer: Three Rivers Provider Network All |
$3,402.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,992.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,134.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,219.41
|
| Rate for Payer: Zelis Auto |
$1,814.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,268.50
|
|
|
IMPLT MESH VENTRALIGHT ST 4 X 6
|
Facility
|
OP
|
$3,898.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7006743
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$974.50 |
| Max. Negotiated Rate |
$3,703.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,338.80
|
| Rate for Payer: Cash Price |
$2,338.80
|
| Rate for Payer: Cash Price |
$2,338.80
|
| Rate for Payer: Cigna Commercial |
$3,313.30
|
| Rate for Payer: First Health Commercial |
$3,508.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,508.20
|
| Rate for Payer: GEHA Commercial |
$3,118.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,508.20
|
| Rate for Payer: Humana ChoiceCare |
$1,013.48
|
| Rate for Payer: Multiplan All |
$3,547.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,338.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,728.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,508.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,703.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,923.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,430.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$974.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,625.14
|
| Rate for Payer: Zelis Auto |
$1,559.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,949.00
|
|
|
IMPLT MESH VENTRALIGHT ST 4 X 6
|
Facility
|
IP
|
$3,898.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7006743
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,559.20 |
| Max. Negotiated Rate |
$3,703.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,118.40
|
| Rate for Payer: Cash Price |
$2,338.80
|
| Rate for Payer: Cash Price |
$2,338.80
|
| Rate for Payer: Cigna Commercial |
$3,313.30
|
| Rate for Payer: First Health Commercial |
$3,508.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,508.20
|
| Rate for Payer: GEHA Commercial |
$2,728.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,508.20
|
| Rate for Payer: Multiplan All |
$3,547.18
|
| Rate for Payer: OMNI Networks Commercial |
$2,728.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,508.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,703.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,923.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,625.14
|
| Rate for Payer: Zelis Auto |
$1,559.20
|
|
|
IMPLT MESH VENTRALIGHT ST 6
|
Facility
|
IP
|
$4,979.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7003224
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,991.60 |
| Max. Negotiated Rate |
$4,730.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,983.20
|
| Rate for Payer: Cash Price |
$2,987.40
|
| Rate for Payer: Cash Price |
$2,987.40
|
| Rate for Payer: Cigna Commercial |
$4,232.15
|
| Rate for Payer: First Health Commercial |
$4,481.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,481.10
|
| Rate for Payer: GEHA Commercial |
$3,485.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,481.10
|
| Rate for Payer: Multiplan All |
$4,530.89
|
| Rate for Payer: OMNI Networks Commercial |
$3,485.30
|
| Rate for Payer: One Health Plan PPO/POS |
$4,481.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,730.05
|
| Rate for Payer: Three Rivers Provider Network All |
$3,734.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,630.47
|
| Rate for Payer: Zelis Auto |
$1,991.60
|
|
|
IMPLT MESH VENTRALIGHT ST 6
|
Facility
|
OP
|
$4,979.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7003224
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,244.75 |
| Max. Negotiated Rate |
$4,730.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,987.40
|
| Rate for Payer: Cash Price |
$2,987.40
|
| Rate for Payer: Cash Price |
$2,987.40
|
| Rate for Payer: Cigna Commercial |
$4,232.15
|
| Rate for Payer: First Health Commercial |
$4,481.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,481.10
|
| Rate for Payer: GEHA Commercial |
$3,983.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,481.10
|
| Rate for Payer: Humana ChoiceCare |
$1,294.54
|
| Rate for Payer: Multiplan All |
$4,530.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,987.40
|
| Rate for Payer: OMNI Networks Commercial |
$3,485.30
|
| Rate for Payer: One Health Plan PPO/POS |
$4,481.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,730.05
|
| Rate for Payer: Three Rivers Provider Network All |
$3,734.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,381.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,244.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,630.47
|
| Rate for Payer: Zelis Auto |
$1,991.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,489.50
|
|
|
IMPLT MESH VENTRALIGHT ST 6X10 OVAL
|
Facility
|
OP
|
$3,904.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002370
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$976.00 |
| Max. Negotiated Rate |
$3,708.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,342.40
|
| Rate for Payer: Cash Price |
$2,342.40
|
| Rate for Payer: Cash Price |
$2,342.40
|
| Rate for Payer: Cigna Commercial |
$3,318.40
|
| Rate for Payer: First Health Commercial |
$3,513.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,513.60
|
| Rate for Payer: GEHA Commercial |
$3,123.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,513.60
|
| Rate for Payer: Humana ChoiceCare |
$1,015.04
|
| Rate for Payer: Multiplan All |
$3,552.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,342.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,732.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,513.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,708.80
|
| Rate for Payer: Three Rivers Provider Network All |
$2,928.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,435.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$976.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,630.72
|
| Rate for Payer: Zelis Auto |
$1,561.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,952.00
|
|
|
IMPLT MESH VENTRALIGHT ST 6X10 OVAL
|
Facility
|
IP
|
$3,904.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002370
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,561.60 |
| Max. Negotiated Rate |
$3,708.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,123.20
|
| Rate for Payer: Cash Price |
$2,342.40
|
| Rate for Payer: Cash Price |
$2,342.40
|
| Rate for Payer: Cigna Commercial |
$3,318.40
|
| Rate for Payer: First Health Commercial |
$3,513.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,513.60
|
| Rate for Payer: GEHA Commercial |
$2,732.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,513.60
|
| Rate for Payer: Multiplan All |
$3,552.64
|
| Rate for Payer: OMNI Networks Commercial |
$2,732.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,513.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,708.80
|
| Rate for Payer: Three Rivers Provider Network All |
$2,928.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,630.72
|
| Rate for Payer: Zelis Auto |
$1,561.60
|
|
|
IMPLT MESH VENTRALIGHT ST 8
|
Facility
|
IP
|
$7,415.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7003225
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,966.00 |
| Max. Negotiated Rate |
$7,044.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,932.00
|
| Rate for Payer: Cash Price |
$4,449.00
|
| Rate for Payer: Cash Price |
$4,449.00
|
| Rate for Payer: Cigna Commercial |
$6,302.75
|
| Rate for Payer: First Health Commercial |
$6,673.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,673.50
|
| Rate for Payer: GEHA Commercial |
$5,190.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,673.50
|
| Rate for Payer: Multiplan All |
$6,747.65
|
| Rate for Payer: OMNI Networks Commercial |
$5,190.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,673.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,044.25
|
| Rate for Payer: Three Rivers Provider Network All |
$5,561.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,895.95
|
| Rate for Payer: Zelis Auto |
$2,966.00
|
|
|
IMPLT MESH VENTRALIGHT ST 8
|
Facility
|
OP
|
$7,415.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7003225
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,853.75 |
| Max. Negotiated Rate |
$7,044.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,449.00
|
| Rate for Payer: Cash Price |
$4,449.00
|
| Rate for Payer: Cash Price |
$4,449.00
|
| Rate for Payer: Cigna Commercial |
$6,302.75
|
| Rate for Payer: First Health Commercial |
$6,673.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,673.50
|
| Rate for Payer: GEHA Commercial |
$5,932.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,673.50
|
| Rate for Payer: Humana ChoiceCare |
$1,927.90
|
| Rate for Payer: Multiplan All |
$6,747.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,449.00
|
| Rate for Payer: OMNI Networks Commercial |
$5,190.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,673.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,044.25
|
| Rate for Payer: Three Rivers Provider Network All |
$5,561.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,525.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,853.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,895.95
|
| Rate for Payer: Zelis Auto |
$2,966.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,707.50
|
|
|
IMPLT MESH VENTRALIGHT ST CIRCLE 20.3CM
|
Facility
|
OP
|
$3,791.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002358
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$947.75 |
| Max. Negotiated Rate |
$3,601.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,274.60
|
| Rate for Payer: Cash Price |
$2,274.60
|
| Rate for Payer: Cash Price |
$2,274.60
|
| Rate for Payer: Cigna Commercial |
$3,222.35
|
| Rate for Payer: First Health Commercial |
$3,411.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,411.90
|
| Rate for Payer: GEHA Commercial |
$3,032.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,411.90
|
| Rate for Payer: Humana ChoiceCare |
$985.66
|
| Rate for Payer: Multiplan All |
$3,449.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,274.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,653.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,411.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,601.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,843.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,336.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$947.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,525.63
|
| Rate for Payer: Zelis Auto |
$1,516.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,895.50
|
|
|
IMPLT MESH VENTRALIGHT ST CIRCLE 20.3CM
|
Facility
|
IP
|
$3,791.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002358
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,516.40 |
| Max. Negotiated Rate |
$3,601.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,032.80
|
| Rate for Payer: Cash Price |
$2,274.60
|
| Rate for Payer: Cash Price |
$2,274.60
|
| Rate for Payer: Cigna Commercial |
$3,222.35
|
| Rate for Payer: First Health Commercial |
$3,411.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,411.90
|
| Rate for Payer: GEHA Commercial |
$2,653.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,411.90
|
| Rate for Payer: Multiplan All |
$3,449.81
|
| Rate for Payer: OMNI Networks Commercial |
$2,653.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,411.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,601.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,843.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,525.63
|
| Rate for Payer: Zelis Auto |
$1,516.40
|
|
|
IMPLT MESH VENTRIO OVAL 10219
|
Facility
|
OP
|
$5,731.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002359
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,432.75 |
| Max. Negotiated Rate |
$5,444.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,438.60
|
| Rate for Payer: Cash Price |
$3,438.60
|
| Rate for Payer: Cash Price |
$3,438.60
|
| Rate for Payer: Cigna Commercial |
$4,871.35
|
| Rate for Payer: First Health Commercial |
$5,157.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,157.90
|
| Rate for Payer: GEHA Commercial |
$4,584.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,157.90
|
| Rate for Payer: Humana ChoiceCare |
$1,490.06
|
| Rate for Payer: Multiplan All |
$5,215.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,438.60
|
| Rate for Payer: OMNI Networks Commercial |
$4,011.70
|
| Rate for Payer: One Health Plan PPO/POS |
$5,157.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,444.45
|
| Rate for Payer: Three Rivers Provider Network All |
$4,298.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,043.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,432.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,329.83
|
| Rate for Payer: Zelis Auto |
$2,292.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,865.50
|
|
|
IMPLT MESH VENTRIO OVAL 10219
|
Facility
|
IP
|
$5,731.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002359
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,292.40 |
| Max. Negotiated Rate |
$5,444.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,584.80
|
| Rate for Payer: Cash Price |
$3,438.60
|
| Rate for Payer: Cash Price |
$3,438.60
|
| Rate for Payer: Cigna Commercial |
$4,871.35
|
| Rate for Payer: First Health Commercial |
$5,157.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,157.90
|
| Rate for Payer: GEHA Commercial |
$4,011.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,157.90
|
| Rate for Payer: Multiplan All |
$5,215.21
|
| Rate for Payer: OMNI Networks Commercial |
$4,011.70
|
| Rate for Payer: One Health Plan PPO/POS |
$5,157.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,444.45
|
| Rate for Payer: Three Rivers Provider Network All |
$4,298.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,329.83
|
| Rate for Payer: Zelis Auto |
$2,292.40
|
|
|
IMPLT MESH VENTRIO SM OVAL 10211
|
Facility
|
IP
|
$2,363.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002360
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$945.20 |
| Max. Negotiated Rate |
$2,244.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,890.40
|
| Rate for Payer: Cash Price |
$1,417.80
|
| Rate for Payer: Cash Price |
$1,417.80
|
| Rate for Payer: Cigna Commercial |
$2,008.55
|
| Rate for Payer: First Health Commercial |
$2,126.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,126.70
|
| Rate for Payer: GEHA Commercial |
$1,654.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,126.70
|
| Rate for Payer: Multiplan All |
$2,150.33
|
| Rate for Payer: OMNI Networks Commercial |
$1,654.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,126.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,244.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,772.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,197.59
|
| Rate for Payer: Zelis Auto |
$945.20
|
|
|
IMPLT MESH VENTRIO SM OVAL 10211
|
Facility
|
OP
|
$2,363.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002360
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$590.75 |
| Max. Negotiated Rate |
$2,244.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,417.80
|
| Rate for Payer: Cash Price |
$1,417.80
|
| Rate for Payer: Cash Price |
$1,417.80
|
| Rate for Payer: Cigna Commercial |
$2,008.55
|
| Rate for Payer: First Health Commercial |
$2,126.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,126.70
|
| Rate for Payer: GEHA Commercial |
$1,890.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,126.70
|
| Rate for Payer: Humana ChoiceCare |
$614.38
|
| Rate for Payer: Multiplan All |
$2,150.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,417.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,654.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,126.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,244.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,772.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,079.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$590.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,197.59
|
| Rate for Payer: Zelis Auto |
$945.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,181.50
|
|
|
IMPLT MESH VENTRIO ST 11X14CM
|
Facility
|
OP
|
$4,949.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002375
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,237.25 |
| Max. Negotiated Rate |
$4,701.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,969.40
|
| Rate for Payer: Cash Price |
$2,969.40
|
| Rate for Payer: Cash Price |
$2,969.40
|
| Rate for Payer: Cigna Commercial |
$4,206.65
|
| Rate for Payer: First Health Commercial |
$4,454.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,454.10
|
| Rate for Payer: GEHA Commercial |
$3,959.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,454.10
|
| Rate for Payer: Humana ChoiceCare |
$1,286.74
|
| Rate for Payer: Multiplan All |
$4,503.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,969.40
|
| Rate for Payer: OMNI Networks Commercial |
$3,464.30
|
| Rate for Payer: One Health Plan PPO/POS |
$4,454.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,701.55
|
| Rate for Payer: Three Rivers Provider Network All |
$3,711.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,355.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,237.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,602.57
|
| Rate for Payer: Zelis Auto |
$1,979.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,474.50
|
|
|
IMPLT MESH VENTRIO ST 11X14CM
|
Facility
|
IP
|
$4,949.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002375
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,979.60 |
| Max. Negotiated Rate |
$4,701.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,959.20
|
| Rate for Payer: Cash Price |
$2,969.40
|
| Rate for Payer: Cash Price |
$2,969.40
|
| Rate for Payer: Cigna Commercial |
$4,206.65
|
| Rate for Payer: First Health Commercial |
$4,454.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,454.10
|
| Rate for Payer: GEHA Commercial |
$3,464.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,454.10
|
| Rate for Payer: Multiplan All |
$4,503.59
|
| Rate for Payer: OMNI Networks Commercial |
$3,464.30
|
| Rate for Payer: One Health Plan PPO/POS |
$4,454.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,701.55
|
| Rate for Payer: Three Rivers Provider Network All |
$3,711.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,602.57
|
| Rate for Payer: Zelis Auto |
$1,979.60
|
|
|
IMPLT MESH VENTRIO ST 13.8X17.8CM
|
Facility
|
OP
|
$4,035.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002376
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,008.75 |
| Max. Negotiated Rate |
$3,833.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,421.00
|
| Rate for Payer: Cash Price |
$2,421.00
|
| Rate for Payer: Cash Price |
$2,421.00
|
| Rate for Payer: Cigna Commercial |
$3,429.75
|
| Rate for Payer: First Health Commercial |
$3,631.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,631.50
|
| Rate for Payer: GEHA Commercial |
$3,228.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,631.50
|
| Rate for Payer: Humana ChoiceCare |
$1,049.10
|
| Rate for Payer: Multiplan All |
$3,671.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,421.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,824.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,631.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,833.25
|
| Rate for Payer: Three Rivers Provider Network All |
$3,026.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,550.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,008.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,752.55
|
| Rate for Payer: Zelis Auto |
$1,614.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,017.50
|
|
