|
IMPLT MESH VENTRIO ST 13.8X17.8CM
|
Facility
|
IP
|
$4,035.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002376
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,614.00 |
| Max. Negotiated Rate |
$3,833.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,228.00
|
| 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 |
$2,824.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,631.50
|
| Rate for Payer: Multiplan All |
$3,671.85
|
| 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: United Payors & United Providers UP&UP |
$3,752.55
|
| Rate for Payer: Zelis Auto |
$1,614.00
|
|
|
IMPLT MESH VENTRIO ST 15.5X25.7CM
|
Facility
|
IP
|
$6,153.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002377
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,461.20 |
| Max. Negotiated Rate |
$5,845.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,922.40
|
| Rate for Payer: Cash Price |
$3,691.80
|
| Rate for Payer: Cash Price |
$3,691.80
|
| Rate for Payer: Cigna Commercial |
$5,230.05
|
| Rate for Payer: First Health Commercial |
$5,537.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,537.70
|
| Rate for Payer: GEHA Commercial |
$4,307.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,537.70
|
| Rate for Payer: Multiplan All |
$5,599.23
|
| Rate for Payer: OMNI Networks Commercial |
$4,307.10
|
| Rate for Payer: One Health Plan PPO/POS |
$5,537.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,845.35
|
| Rate for Payer: Three Rivers Provider Network All |
$4,614.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,722.29
|
| Rate for Payer: Zelis Auto |
$2,461.20
|
|
|
IMPLT MESH VENTRIO ST 15.5X25.7CM
|
Facility
|
OP
|
$6,153.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002377
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,538.25 |
| Max. Negotiated Rate |
$5,845.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,691.80
|
| Rate for Payer: Cash Price |
$3,691.80
|
| Rate for Payer: Cash Price |
$3,691.80
|
| Rate for Payer: Cigna Commercial |
$5,230.05
|
| Rate for Payer: First Health Commercial |
$5,537.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,537.70
|
| Rate for Payer: GEHA Commercial |
$4,922.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,537.70
|
| Rate for Payer: Humana ChoiceCare |
$1,599.78
|
| Rate for Payer: Multiplan All |
$5,599.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,691.80
|
| Rate for Payer: OMNI Networks Commercial |
$4,307.10
|
| Rate for Payer: One Health Plan PPO/POS |
$5,537.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,845.35
|
| Rate for Payer: Three Rivers Provider Network All |
$4,614.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,414.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,538.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,722.29
|
| Rate for Payer: Zelis Auto |
$2,461.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,076.50
|
|
|
IMPLT MESH VENTRIO ST 19.6X24.6CM
|
Facility
|
OP
|
$7,390.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7006545
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,847.50 |
| Max. Negotiated Rate |
$7,020.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,434.00
|
| Rate for Payer: Cash Price |
$4,434.00
|
| Rate for Payer: Cash Price |
$4,434.00
|
| Rate for Payer: Cigna Commercial |
$6,281.50
|
| Rate for Payer: First Health Commercial |
$6,651.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,651.00
|
| Rate for Payer: GEHA Commercial |
$5,912.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,651.00
|
| Rate for Payer: Humana ChoiceCare |
$1,921.40
|
| Rate for Payer: Multiplan All |
$6,724.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,434.00
|
| Rate for Payer: OMNI Networks Commercial |
$5,173.00
|
| Rate for Payer: One Health Plan PPO/POS |
$6,651.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,020.50
|
| Rate for Payer: Three Rivers Provider Network All |
$5,542.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,503.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,847.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,872.70
|
| Rate for Payer: Zelis Auto |
$2,956.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,695.00
|
|
|
IMPLT MESH VENTRIO ST 19.6X24.6CM
|
Facility
|
IP
|
$7,390.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7006545
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,956.00 |
| Max. Negotiated Rate |
$7,020.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,912.00
|
| Rate for Payer: Cash Price |
$4,434.00
|
| Rate for Payer: Cash Price |
$4,434.00
|
| Rate for Payer: Cigna Commercial |
$6,281.50
|
| Rate for Payer: First Health Commercial |
$6,651.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,651.00
|
| Rate for Payer: GEHA Commercial |
$5,173.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,651.00
|
| Rate for Payer: Multiplan All |
$6,724.90
|
| Rate for Payer: OMNI Networks Commercial |
$5,173.00
|
| Rate for Payer: One Health Plan PPO/POS |
$6,651.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,020.50
|
| Rate for Payer: Three Rivers Provider Network All |
$5,542.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,872.70
|
| Rate for Payer: Zelis Auto |
$2,956.00
|
|
|
IMPLT MESH VENTRIO ST 7.6 X 7.6
|
Facility
|
IP
|
$2,087.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002374
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$834.80 |
| Max. Negotiated Rate |
$1,982.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,669.60
|
| Rate for Payer: Cash Price |
$1,252.20
|
| Rate for Payer: Cash Price |
$1,252.20
|
| Rate for Payer: Cigna Commercial |
$1,773.95
|
| Rate for Payer: First Health Commercial |
$1,878.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,878.30
|
| Rate for Payer: GEHA Commercial |
$1,460.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,878.30
|
| Rate for Payer: Multiplan All |
$1,899.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,460.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,878.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,982.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,565.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,940.91
|
| Rate for Payer: Zelis Auto |
$834.80
|
|
|
IMPLT MESH VENTRIO ST 7.6 X 7.6
|
Facility
|
OP
|
$2,087.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002374
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$521.75 |
| Max. Negotiated Rate |
$1,982.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,252.20
|
| Rate for Payer: Cash Price |
$1,252.20
|
| Rate for Payer: Cash Price |
$1,252.20
|
| Rate for Payer: Cigna Commercial |
$1,773.95
|
| Rate for Payer: First Health Commercial |
$1,878.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,878.30
|
| Rate for Payer: GEHA Commercial |
$1,669.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,878.30
|
| Rate for Payer: Humana ChoiceCare |
$542.62
|
| Rate for Payer: Multiplan All |
$1,899.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,252.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,460.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,878.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,982.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,565.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,836.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$521.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,940.91
|
| Rate for Payer: Zelis Auto |
$834.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,043.50
|
|
|
IMPLT MESH VENTRIO ST 8X12CM
|
Facility
|
OP
|
$3,576.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002378
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$894.00 |
| Max. Negotiated Rate |
$3,397.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,145.60
|
| Rate for Payer: Cash Price |
$2,145.60
|
| Rate for Payer: Cash Price |
$2,145.60
|
| Rate for Payer: Cigna Commercial |
$3,039.60
|
| Rate for Payer: First Health Commercial |
$3,218.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,218.40
|
| Rate for Payer: GEHA Commercial |
$2,860.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,218.40
|
| Rate for Payer: Humana ChoiceCare |
$929.76
|
| Rate for Payer: Multiplan All |
$3,254.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,145.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,503.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,218.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,397.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,682.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,146.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$894.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,325.68
|
| Rate for Payer: Zelis Auto |
$1,430.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,788.00
|
|
|
IMPLT MESH VENTRIO ST 8X12CM
|
Facility
|
IP
|
$3,576.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002378
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,430.40 |
| Max. Negotiated Rate |
$3,397.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,860.80
|
| Rate for Payer: Cash Price |
$2,145.60
|
| Rate for Payer: Cash Price |
$2,145.60
|
| Rate for Payer: Cigna Commercial |
$3,039.60
|
| Rate for Payer: First Health Commercial |
$3,218.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,218.40
|
| Rate for Payer: GEHA Commercial |
$2,503.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,218.40
|
| Rate for Payer: Multiplan All |
$3,254.16
|
| Rate for Payer: OMNI Networks Commercial |
$2,503.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,218.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,397.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,682.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,325.68
|
| Rate for Payer: Zelis Auto |
$1,430.40
|
|
|
IMPLT MESH VENTRIO ST CIR 11.4CM
|
Facility
|
IP
|
$3,742.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002329
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,496.80 |
| Max. Negotiated Rate |
$3,554.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,993.60
|
| Rate for Payer: Cash Price |
$2,245.20
|
| Rate for Payer: Cash Price |
$2,245.20
|
| Rate for Payer: Cigna Commercial |
$3,180.70
|
| Rate for Payer: First Health Commercial |
$3,367.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,367.80
|
| Rate for Payer: GEHA Commercial |
$2,619.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,367.80
|
| Rate for Payer: Multiplan All |
$3,405.22
|
| Rate for Payer: OMNI Networks Commercial |
$2,619.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,367.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,554.90
|
| Rate for Payer: Three Rivers Provider Network All |
$2,806.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,480.06
|
| Rate for Payer: Zelis Auto |
$1,496.80
|
|
|
IMPLT MESH VENTRIO ST CIR 11.4CM
|
Facility
|
OP
|
$3,742.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002329
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$935.50 |
| Max. Negotiated Rate |
$3,554.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,245.20
|
| Rate for Payer: Cash Price |
$2,245.20
|
| Rate for Payer: Cash Price |
$2,245.20
|
| Rate for Payer: Cigna Commercial |
$3,180.70
|
| Rate for Payer: First Health Commercial |
$3,367.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,367.80
|
| Rate for Payer: GEHA Commercial |
$2,993.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,367.80
|
| Rate for Payer: Humana ChoiceCare |
$972.92
|
| Rate for Payer: Multiplan All |
$3,405.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,245.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,619.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,367.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,554.90
|
| Rate for Payer: Three Rivers Provider Network All |
$2,806.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,292.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$935.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,480.06
|
| Rate for Payer: Zelis Auto |
$1,496.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,871.00
|
|
|
IMPLT MESH VICRYL KNITTED 30X30CM
|
Facility
|
IP
|
$3,345.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002379
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,338.00 |
| Max. Negotiated Rate |
$3,177.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,676.00
|
| Rate for Payer: Cash Price |
$2,007.00
|
| Rate for Payer: Cash Price |
$2,007.00
|
| Rate for Payer: Cigna Commercial |
$2,843.25
|
| Rate for Payer: First Health Commercial |
$3,010.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,010.50
|
| Rate for Payer: GEHA Commercial |
$2,341.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,010.50
|
| Rate for Payer: Multiplan All |
$3,043.95
|
| Rate for Payer: OMNI Networks Commercial |
$2,341.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,010.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,177.75
|
| Rate for Payer: Three Rivers Provider Network All |
$2,508.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,110.85
|
| Rate for Payer: Zelis Auto |
$1,338.00
|
|
|
IMPLT MESH VICRYL KNITTED 30X30CM
|
Facility
|
OP
|
$3,345.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002379
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$836.25 |
| Max. Negotiated Rate |
$3,177.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,007.00
|
| Rate for Payer: Cash Price |
$2,007.00
|
| Rate for Payer: Cash Price |
$2,007.00
|
| Rate for Payer: Cigna Commercial |
$2,843.25
|
| Rate for Payer: First Health Commercial |
$3,010.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,010.50
|
| Rate for Payer: GEHA Commercial |
$2,676.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,010.50
|
| Rate for Payer: Humana ChoiceCare |
$869.70
|
| Rate for Payer: Multiplan All |
$3,043.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,007.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,341.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,010.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,177.75
|
| Rate for Payer: Three Rivers Provider Network All |
$2,508.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,943.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$836.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,110.85
|
| Rate for Payer: Zelis Auto |
$1,338.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,672.50
|
|
|
IMPLT MESH V-PATCH 4.3CMX4.3CM
|
Facility
|
IP
|
$1,596.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002986
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.40 |
| Max. Negotiated Rate |
$1,516.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,276.80
|
| Rate for Payer: Cash Price |
$957.60
|
| Rate for Payer: Cash Price |
$957.60
|
| Rate for Payer: Cigna Commercial |
$1,356.60
|
| Rate for Payer: First Health Commercial |
$1,436.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,436.40
|
| Rate for Payer: GEHA Commercial |
$1,117.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,436.40
|
| Rate for Payer: Multiplan All |
$1,452.36
|
| Rate for Payer: OMNI Networks Commercial |
$1,117.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,436.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,516.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,197.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,484.28
|
| Rate for Payer: Zelis Auto |
$638.40
|
|
|
IMPLT MESH V-PATCH 4.3CMX4.3CM
|
Facility
|
OP
|
$1,596.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002986
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$399.00 |
| Max. Negotiated Rate |
$1,516.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$957.60
|
| Rate for Payer: Cash Price |
$957.60
|
| Rate for Payer: Cash Price |
$957.60
|
| Rate for Payer: Cigna Commercial |
$1,356.60
|
| Rate for Payer: First Health Commercial |
$1,436.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,436.40
|
| Rate for Payer: GEHA Commercial |
$1,276.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,436.40
|
| Rate for Payer: Humana ChoiceCare |
$414.96
|
| Rate for Payer: Multiplan All |
$1,452.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$957.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,117.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,436.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,516.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,197.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,404.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$399.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,484.28
|
| Rate for Payer: Zelis Auto |
$638.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$798.00
|
|
|
IMPLT METACARPOPHALANGEAL
|
Facility
|
OP
|
$3,965.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001874
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$991.25 |
| Max. Negotiated Rate |
$3,766.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,379.00
|
| Rate for Payer: Cash Price |
$2,379.00
|
| Rate for Payer: Cash Price |
$2,379.00
|
| Rate for Payer: Cigna Commercial |
$3,370.25
|
| Rate for Payer: First Health Commercial |
$3,568.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,568.50
|
| Rate for Payer: GEHA Commercial |
$3,172.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,568.50
|
| Rate for Payer: Humana ChoiceCare |
$1,030.90
|
| Rate for Payer: Multiplan All |
$3,608.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,379.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,775.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,568.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,766.75
|
| Rate for Payer: Three Rivers Provider Network All |
$2,973.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,489.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$991.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,687.45
|
| Rate for Payer: Zelis Auto |
$1,586.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,982.50
|
|
|
IMPLT METACARPOPHALANGEAL
|
Facility
|
IP
|
$3,965.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001874
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,586.00 |
| Max. Negotiated Rate |
$3,766.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,172.00
|
| Rate for Payer: Cash Price |
$2,379.00
|
| Rate for Payer: Cash Price |
$2,379.00
|
| Rate for Payer: Cigna Commercial |
$3,370.25
|
| Rate for Payer: First Health Commercial |
$3,568.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,568.50
|
| Rate for Payer: GEHA Commercial |
$2,775.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,568.50
|
| Rate for Payer: Multiplan All |
$3,608.15
|
| Rate for Payer: OMNI Networks Commercial |
$2,775.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,568.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,766.75
|
| Rate for Payer: Three Rivers Provider Network All |
$2,973.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,687.45
|
| Rate for Payer: Zelis Auto |
$1,586.00
|
|
|
IMPLT METACARPOPHALANGEAL PREFLEX 50MM
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002097
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,000.00 |
| Max. Negotiated Rate |
$4,750.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,000.00
|
| Rate for Payer: Cash Price |
$3,000.00
|
| Rate for Payer: Cash Price |
$3,000.00
|
| Rate for Payer: Cigna Commercial |
$4,250.00
|
| Rate for Payer: First Health Commercial |
$4,500.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,500.00
|
| Rate for Payer: GEHA Commercial |
$3,500.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,500.00
|
| Rate for Payer: Multiplan All |
$4,550.00
|
| Rate for Payer: OMNI Networks Commercial |
$3,500.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,500.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,750.00
|
| Rate for Payer: Three Rivers Provider Network All |
$3,750.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,650.00
|
| Rate for Payer: Zelis Auto |
$2,000.00
|
|
|
IMPLT METACARPOPHALANGEAL PREFLEX 50MM
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002097
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,250.00 |
| Max. Negotiated Rate |
$4,750.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,000.00
|
| Rate for Payer: Cash Price |
$3,000.00
|
| Rate for Payer: Cash Price |
$3,000.00
|
| Rate for Payer: Cigna Commercial |
$4,250.00
|
| Rate for Payer: First Health Commercial |
$4,500.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,500.00
|
| Rate for Payer: GEHA Commercial |
$4,000.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,500.00
|
| Rate for Payer: Humana ChoiceCare |
$1,300.00
|
| Rate for Payer: Multiplan All |
$4,550.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,000.00
|
| Rate for Payer: OMNI Networks Commercial |
$3,500.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,500.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,750.00
|
| Rate for Payer: Three Rivers Provider Network All |
$3,750.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,400.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,250.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,650.00
|
| Rate for Payer: Zelis Auto |
$2,000.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,500.00
|
|
|
IMPLT MICRORAPTOR KNOTLESS SA PEEK
|
Facility
|
OP
|
$2,351.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009048
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$587.75 |
| Max. Negotiated Rate |
$2,233.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,410.60
|
| Rate for Payer: Cash Price |
$1,410.60
|
| Rate for Payer: Cash Price |
$1,410.60
|
| Rate for Payer: Cigna Commercial |
$1,998.35
|
| Rate for Payer: First Health Commercial |
$2,115.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,115.90
|
| Rate for Payer: GEHA Commercial |
$1,880.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,115.90
|
| Rate for Payer: Humana ChoiceCare |
$611.26
|
| Rate for Payer: Multiplan All |
$2,139.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,410.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,645.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,115.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,233.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,763.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,068.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$587.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,186.43
|
| Rate for Payer: Zelis Auto |
$940.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,175.50
|
|
|
IMPLT MICRORAPTOR KNOTLESS SA PEEK
|
Facility
|
IP
|
$2,351.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009048
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$940.40 |
| Max. Negotiated Rate |
$2,233.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,880.80
|
| Rate for Payer: Cash Price |
$1,410.60
|
| Rate for Payer: Cash Price |
$1,410.60
|
| Rate for Payer: Cigna Commercial |
$1,998.35
|
| Rate for Payer: First Health Commercial |
$2,115.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,115.90
|
| Rate for Payer: GEHA Commercial |
$1,645.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,115.90
|
| Rate for Payer: Multiplan All |
$2,139.41
|
| Rate for Payer: OMNI Networks Commercial |
$1,645.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,115.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,233.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,763.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,186.43
|
| Rate for Payer: Zelis Auto |
$940.40
|
|
|
IMPLT MINITAC 2.0
|
Facility
|
IP
|
$1,269.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$507.60 |
| Max. Negotiated Rate |
$1,205.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,015.20
|
| Rate for Payer: Cash Price |
$761.40
|
| Rate for Payer: Cash Price |
$761.40
|
| Rate for Payer: Cigna Commercial |
$1,078.65
|
| Rate for Payer: First Health Commercial |
$1,142.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,142.10
|
| Rate for Payer: GEHA Commercial |
$888.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,142.10
|
| Rate for Payer: Multiplan All |
$1,154.79
|
| Rate for Payer: OMNI Networks Commercial |
$888.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,142.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,205.55
|
| Rate for Payer: Three Rivers Provider Network All |
$951.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,180.17
|
| Rate for Payer: Zelis Auto |
$507.60
|
|
|
IMPLT MINITAC 2.0
|
Facility
|
OP
|
$1,269.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$317.25 |
| Max. Negotiated Rate |
$1,205.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$761.40
|
| Rate for Payer: Cash Price |
$761.40
|
| Rate for Payer: Cash Price |
$761.40
|
| Rate for Payer: Cigna Commercial |
$1,078.65
|
| Rate for Payer: First Health Commercial |
$1,142.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,142.10
|
| Rate for Payer: GEHA Commercial |
$1,015.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,142.10
|
| Rate for Payer: Humana ChoiceCare |
$329.94
|
| Rate for Payer: Multiplan All |
$1,154.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$761.40
|
| Rate for Payer: OMNI Networks Commercial |
$888.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,142.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,205.55
|
| Rate for Payer: Three Rivers Provider Network All |
$951.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,116.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$317.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,180.17
|
| Rate for Payer: Zelis Auto |
$507.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$634.50
|
|
|
IMPLT MIRENA 52MG SYSTEM IUD
|
Facility
|
IP
|
$3,665.00
|
|
|
Service Code
|
CPT C2617
|
| Hospital Charge Code |
7006561
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,466.00 |
| Max. Negotiated Rate |
$3,481.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,932.00
|
| Rate for Payer: Cash Price |
$2,199.00
|
| Rate for Payer: Cash Price |
$2,199.00
|
| Rate for Payer: Cigna Commercial |
$3,115.25
|
| Rate for Payer: First Health Commercial |
$3,298.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,298.50
|
| Rate for Payer: GEHA Commercial |
$2,565.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,298.50
|
| Rate for Payer: Multiplan All |
$3,335.15
|
| Rate for Payer: OMNI Networks Commercial |
$2,565.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,298.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,481.75
|
| Rate for Payer: Three Rivers Provider Network All |
$2,748.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,408.45
|
| Rate for Payer: Zelis Auto |
$1,466.00
|
|
|
IMPLT MIRENA 52MG SYSTEM IUD
|
Facility
|
OP
|
$3,665.00
|
|
|
Service Code
|
CPT C2617
|
| Hospital Charge Code |
7006561
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$916.25 |
| Max. Negotiated Rate |
$3,481.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,199.00
|
| Rate for Payer: Cash Price |
$2,199.00
|
| Rate for Payer: Cash Price |
$2,199.00
|
| Rate for Payer: Cigna Commercial |
$3,115.25
|
| Rate for Payer: First Health Commercial |
$3,298.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,298.50
|
| Rate for Payer: GEHA Commercial |
$2,932.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,298.50
|
| Rate for Payer: Humana ChoiceCare |
$952.90
|
| Rate for Payer: Multiplan All |
$3,335.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,199.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,565.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,298.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,481.75
|
| Rate for Payer: Three Rivers Provider Network All |
$2,748.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,225.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$916.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,408.45
|
| Rate for Payer: Zelis Auto |
$1,466.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,832.50
|
|
