|
PSYCL/NRPSYCL TST ELEC PATFORM AUTO RESU
|
Facility
|
OP
|
$203.00
|
|
|
Service Code
|
CPT 96146
|
| Hospital Charge Code |
4397919
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.76 |
| Max. Negotiated Rate |
$192.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$25.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$121.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$25.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$20.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$23.25
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cigna Commercial |
$172.55
|
| Rate for Payer: First Health Commercial |
$182.70
|
| Rate for Payer: First Health Workers Compensation |
$78.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$182.70
|
| Rate for Payer: GEHA Commercial |
$162.40
|
| Rate for Payer: GEHA Medicare |
$23.25
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$182.70
|
| Rate for Payer: Humana ChoiceCare |
$25.57
|
| Rate for Payer: Humana Medicare Advantage |
$23.25
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$39.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$20.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$23.25
|
| Rate for Payer: Multiplan All |
$184.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$39.52
|
| Rate for Payer: OMNI Networks Commercial |
$142.10
|
| Rate for Payer: One Health Plan PPO/POS |
$182.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$24.04
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$20.82
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$23.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$192.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$46.50
|
| Rate for Payer: Three Rivers Provider Network All |
$152.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$22.79
|
| Rate for Payer: United Healthcare Commercial |
$172.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$20.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$188.79
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$23.25
|
| Rate for Payer: Zelis Auto |
$81.20
|
| Rate for Payer: Zelis Medicare |
$19.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$27.90
|
| Rate for Payer: Zelis Worker's Compensation |
$55.42
|
|
|
PSYCL/NRPSYCL TST ELEC PATFORM AUTO RESU
|
Facility
|
IP
|
$203.00
|
|
|
Service Code
|
CPT 96146
|
| Hospital Charge Code |
4397919
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$55.42 |
| Max. Negotiated Rate |
$192.85 |
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cigna Commercial |
$172.55
|
| Rate for Payer: First Health Commercial |
$182.70
|
| Rate for Payer: First Health Workers Compensation |
$78.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$182.70
|
| Rate for Payer: GEHA Commercial |
$142.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$182.70
|
| Rate for Payer: Multiplan All |
$184.73
|
| Rate for Payer: OMNI Networks Commercial |
$142.10
|
| Rate for Payer: One Health Plan PPO/POS |
$182.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$192.85
|
| Rate for Payer: Three Rivers Provider Network All |
$152.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$188.79
|
| Rate for Payer: Zelis Auto |
$81.20
|
| Rate for Payer: Zelis Worker's Compensation |
$55.42
|
|
|
PSYCL/NRPSYCL TST PHYS/QHP 2+ TST EA ADD
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 96137
|
| Hospital Charge Code |
4397916
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$78.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$78.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$36.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$78.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$62.50
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$51.00
|
| Rate for Payer: First Health Commercial |
$54.00
|
| Rate for Payer: First Health Workers Compensation |
$23.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$54.00
|
| Rate for Payer: GEHA Commercial |
$48.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$54.00
|
| Rate for Payer: Humana ChoiceCare |
$15.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$63.78
|
| Rate for Payer: Multiplan All |
$54.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$36.00
|
| Rate for Payer: OMNI Networks Commercial |
$42.00
|
| Rate for Payer: One Health Plan PPO/POS |
$54.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$73.64
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$63.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$57.00
|
| Rate for Payer: Three Rivers Provider Network All |
$45.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$52.80
|
| Rate for Payer: United Healthcare Commercial |
$51.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$55.80
|
| Rate for Payer: Zelis Auto |
$24.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$30.00
|
| Rate for Payer: Zelis Worker's Compensation |
$16.38
|
|
|
PSYCL/NRPSYCL TST PHYS/QHP 2+ TST EA ADD
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 96137
|
| Hospital Charge Code |
4397916
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$51.00
|
| Rate for Payer: First Health Commercial |
$54.00
|
| Rate for Payer: First Health Workers Compensation |
$23.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$54.00
|
| Rate for Payer: GEHA Commercial |
$42.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$54.00
|
| Rate for Payer: Multiplan All |
$54.60
|
| Rate for Payer: OMNI Networks Commercial |
$42.00
|
| Rate for Payer: One Health Plan PPO/POS |
$54.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$57.00
|
| Rate for Payer: Three Rivers Provider Network All |
$45.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$55.80
|
| Rate for Payer: Zelis Auto |
$24.00
|
| Rate for Payer: Zelis Worker's Compensation |
$16.38
|
|
|
PSYCL/NRPSYCL TST TECH 2+ TST 1ST 30 MIN
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 96138
|
| Hospital Charge Code |
4397917
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$30.03 |
| Max. Negotiated Rate |
$104.50 |
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$93.50
|
| Rate for Payer: First Health Commercial |
$99.00
|
| Rate for Payer: First Health Workers Compensation |
$42.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$99.00
|
| Rate for Payer: GEHA Commercial |
$77.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$99.00
|
| Rate for Payer: Multiplan All |
$100.10
|
| Rate for Payer: OMNI Networks Commercial |
$77.00
|
| Rate for Payer: One Health Plan PPO/POS |
$99.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$104.50
|
| Rate for Payer: Three Rivers Provider Network All |
$82.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$102.30
|
| Rate for Payer: Zelis Auto |
$44.00
|
| Rate for Payer: Zelis Worker's Compensation |
$30.03
|
|
|
PSYCL/NRPSYCL TST TECH 2+ TST 1ST 30 MIN
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 96138
|
| Hospital Charge Code |
4397917
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$757.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$25.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$66.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$25.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$20.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$378.90
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$93.50
|
| Rate for Payer: First Health Commercial |
$99.00
|
| Rate for Payer: First Health Workers Compensation |
$42.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$99.00
|
| Rate for Payer: GEHA Commercial |
$88.00
|
| Rate for Payer: GEHA Medicare |
$378.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$99.00
|
| Rate for Payer: Humana ChoiceCare |
$416.79
|
| Rate for Payer: Humana Medicare Advantage |
$378.90
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$636.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$20.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$378.90
|
| Rate for Payer: Multiplan All |
$100.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.13
|
| Rate for Payer: OMNI Networks Commercial |
$77.00
|
| Rate for Payer: One Health Plan PPO/POS |
$99.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$24.04
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$20.82
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$378.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$104.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$757.80
|
| Rate for Payer: Three Rivers Provider Network All |
$82.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.32
|
| Rate for Payer: United Healthcare Commercial |
$93.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$20.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$378.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$102.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$378.90
|
| Rate for Payer: Zelis Auto |
$44.00
|
| Rate for Payer: Zelis Medicare |
$322.06
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$454.68
|
| Rate for Payer: Zelis Worker's Compensation |
$30.03
|
|
|
PSYCL/NRPSYCL TST TECH 2+ TST EA ADDL 30
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 96139
|
| Hospital Charge Code |
4397918
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$30.03 |
| Max. Negotiated Rate |
$104.50 |
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$93.50
|
| Rate for Payer: First Health Commercial |
$99.00
|
| Rate for Payer: First Health Workers Compensation |
$42.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$99.00
|
| Rate for Payer: GEHA Commercial |
$77.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$99.00
|
| Rate for Payer: Multiplan All |
$100.10
|
| Rate for Payer: OMNI Networks Commercial |
$77.00
|
| Rate for Payer: One Health Plan PPO/POS |
$99.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$104.50
|
| Rate for Payer: Three Rivers Provider Network All |
$82.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$102.30
|
| Rate for Payer: Zelis Auto |
$44.00
|
| Rate for Payer: Zelis Worker's Compensation |
$30.03
|
|
|
PSYCL/NRPSYCL TST TECH 2+ TST EA ADDL 30
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 96139
|
| Hospital Charge Code |
4397918
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$28.60 |
| Max. Negotiated Rate |
$104.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$71.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$66.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$71.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$56.33
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$93.50
|
| Rate for Payer: First Health Commercial |
$99.00
|
| Rate for Payer: First Health Workers Compensation |
$42.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$99.00
|
| Rate for Payer: GEHA Commercial |
$88.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$99.00
|
| Rate for Payer: Humana ChoiceCare |
$28.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$57.47
|
| Rate for Payer: Multiplan All |
$100.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$66.00
|
| Rate for Payer: OMNI Networks Commercial |
$77.00
|
| Rate for Payer: One Health Plan PPO/POS |
$99.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$66.36
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$57.47
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$104.50
|
| Rate for Payer: Three Rivers Provider Network All |
$82.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$96.80
|
| Rate for Payer: United Healthcare Commercial |
$93.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$57.47
|
| Rate for Payer: United Payors & United Providers UP&UP |
$102.30
|
| Rate for Payer: Zelis Auto |
$44.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$55.00
|
| Rate for Payer: Zelis Worker's Compensation |
$30.03
|
|
|
PSYCL/NRPSYC TST PHY/QHP 1ST
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 96136
|
| Hospital Charge Code |
4397915
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$25.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$45.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$25.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$20.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$64.60
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: First Health Workers Compensation |
$29.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$68.40
|
| Rate for Payer: GEHA Commercial |
$60.80
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$68.40
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$20.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$69.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$53.20
|
| Rate for Payer: One Health Plan PPO/POS |
$68.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$24.04
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$20.82
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$72.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$57.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Commercial |
$64.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$20.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$70.68
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$30.40
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$20.75
|
|
|
PSYCL/NRPSYC TST PHY/QHP 1ST
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 96136
|
| Hospital Charge Code |
4397915
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.75 |
| Max. Negotiated Rate |
$72.20 |
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$64.60
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: First Health Workers Compensation |
$29.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$68.40
|
| Rate for Payer: GEHA Commercial |
$53.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$68.40
|
| Rate for Payer: Multiplan All |
$69.16
|
| Rate for Payer: OMNI Networks Commercial |
$53.20
|
| Rate for Payer: One Health Plan PPO/POS |
$68.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$72.20
|
| Rate for Payer: Three Rivers Provider Network All |
$57.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$70.68
|
| Rate for Payer: Zelis Auto |
$30.40
|
| Rate for Payer: Zelis Worker's Compensation |
$20.75
|
|
|
PSYCL TST EVAL PHYS/QHP 1ST
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 96130
|
| Hospital Charge Code |
4397911
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$92.55 |
| Max. Negotiated Rate |
$322.05 |
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cigna Commercial |
$288.15
|
| Rate for Payer: First Health Commercial |
$305.10
|
| Rate for Payer: First Health Workers Compensation |
$130.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$305.10
|
| Rate for Payer: GEHA Commercial |
$237.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$305.10
|
| Rate for Payer: Multiplan All |
$308.49
|
| Rate for Payer: OMNI Networks Commercial |
$237.30
|
| Rate for Payer: One Health Plan PPO/POS |
$305.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$322.05
|
| Rate for Payer: Three Rivers Provider Network All |
$254.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$315.27
|
| Rate for Payer: Zelis Auto |
$135.60
|
| Rate for Payer: Zelis Worker's Compensation |
$92.55
|
|
|
PSYCL TST EVAL PHYS/QHP 1ST
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT 96130
|
| Hospital Charge Code |
4397911
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$92.55 |
| Max. Negotiated Rate |
$591.38 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$203.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$203.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$203.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$161.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$295.69
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cigna Commercial |
$288.15
|
| Rate for Payer: First Health Commercial |
$305.10
|
| Rate for Payer: First Health Workers Compensation |
$130.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$305.10
|
| Rate for Payer: GEHA Commercial |
$271.20
|
| Rate for Payer: GEHA Medicare |
$295.69
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$305.10
|
| Rate for Payer: Humana ChoiceCare |
$325.26
|
| Rate for Payer: Humana Medicare Advantage |
$295.69
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$496.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$164.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$295.69
|
| Rate for Payer: Multiplan All |
$308.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$502.67
|
| Rate for Payer: OMNI Networks Commercial |
$237.30
|
| Rate for Payer: One Health Plan PPO/POS |
$305.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$190.33
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$164.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$295.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$322.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$591.38
|
| Rate for Payer: Three Rivers Provider Network All |
$254.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$289.78
|
| Rate for Payer: United Healthcare Commercial |
$288.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$164.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$295.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$315.27
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$295.69
|
| Rate for Payer: Zelis Auto |
$135.60
|
| Rate for Payer: Zelis Medicare |
$251.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$354.83
|
| Rate for Payer: Zelis Worker's Compensation |
$92.55
|
|
|
PSYCL TST EVAL PHYS/QHP EA
|
Facility
|
OP
|
$258.00
|
|
|
Service Code
|
CPT 96131
|
| Hospital Charge Code |
4397912
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$67.08 |
| Max. Negotiated Rate |
$245.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$186.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$154.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$186.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$147.49
|
| Rate for Payer: Cash Price |
$154.80
|
| Rate for Payer: Cash Price |
$154.80
|
| Rate for Payer: Cigna Commercial |
$219.30
|
| Rate for Payer: First Health Commercial |
$232.20
|
| Rate for Payer: First Health Workers Compensation |
$99.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$232.20
|
| Rate for Payer: GEHA Commercial |
$206.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$232.20
|
| Rate for Payer: Humana ChoiceCare |
$67.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$150.50
|
| Rate for Payer: Multiplan All |
$234.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$154.80
|
| Rate for Payer: OMNI Networks Commercial |
$180.60
|
| Rate for Payer: One Health Plan PPO/POS |
$232.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$173.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$150.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$245.10
|
| Rate for Payer: Three Rivers Provider Network All |
$193.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$227.04
|
| Rate for Payer: United Healthcare Commercial |
$219.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$150.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$239.94
|
| Rate for Payer: Zelis Auto |
$103.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$129.00
|
| Rate for Payer: Zelis Worker's Compensation |
$70.43
|
|
|
PSYCL TST EVAL PHYS/QHP EA
|
Facility
|
IP
|
$258.00
|
|
|
Service Code
|
CPT 96131
|
| Hospital Charge Code |
4397912
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$70.43 |
| Max. Negotiated Rate |
$245.10 |
| Rate for Payer: Cash Price |
$154.80
|
| Rate for Payer: Cigna Commercial |
$219.30
|
| Rate for Payer: First Health Commercial |
$232.20
|
| Rate for Payer: First Health Workers Compensation |
$99.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$232.20
|
| Rate for Payer: GEHA Commercial |
$180.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$232.20
|
| Rate for Payer: Multiplan All |
$234.78
|
| Rate for Payer: OMNI Networks Commercial |
$180.60
|
| Rate for Payer: One Health Plan PPO/POS |
$232.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$245.10
|
| Rate for Payer: Three Rivers Provider Network All |
$193.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$239.94
|
| Rate for Payer: Zelis Auto |
$103.20
|
| Rate for Payer: Zelis Worker's Compensation |
$70.43
|
|
|
PSYTX CRISIS EA ADDL 30 MIN
|
Facility
|
IP
|
$301.00
|
|
|
Service Code
|
CPT 90840
|
| Hospital Charge Code |
8590840
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$82.17 |
| Max. Negotiated Rate |
$285.95 |
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$255.85
|
| Rate for Payer: First Health Commercial |
$270.90
|
| Rate for Payer: First Health Workers Compensation |
$116.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$270.90
|
| Rate for Payer: GEHA Commercial |
$210.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$270.90
|
| Rate for Payer: Multiplan All |
$273.91
|
| Rate for Payer: OMNI Networks Commercial |
$210.70
|
| Rate for Payer: One Health Plan PPO/POS |
$270.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$285.95
|
| Rate for Payer: Three Rivers Provider Network All |
$225.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$279.93
|
| Rate for Payer: Zelis Auto |
$120.40
|
| Rate for Payer: Zelis Worker's Compensation |
$82.17
|
|
|
PSYTX CRISIS EA ADDL 30 MIN
|
Facility
|
OP
|
$301.00
|
|
|
Service Code
|
CPT 90840
|
| Hospital Charge Code |
8590840
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$41.59 |
| Max. Negotiated Rate |
$285.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$52.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$180.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$52.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$41.59
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$255.85
|
| Rate for Payer: First Health Commercial |
$270.90
|
| Rate for Payer: First Health Workers Compensation |
$116.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$270.90
|
| Rate for Payer: GEHA Commercial |
$240.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$270.90
|
| Rate for Payer: Humana ChoiceCare |
$78.26
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$42.44
|
| Rate for Payer: Multiplan All |
$273.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$180.60
|
| Rate for Payer: OMNI Networks Commercial |
$210.70
|
| Rate for Payer: One Health Plan PPO/POS |
$270.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$49.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$42.44
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$285.95
|
| Rate for Payer: Three Rivers Provider Network All |
$225.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$264.88
|
| Rate for Payer: United Healthcare Commercial |
$255.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$42.44
|
| Rate for Payer: United Payors & United Providers UP&UP |
$279.93
|
| Rate for Payer: Zelis Auto |
$120.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$150.50
|
| Rate for Payer: Zelis Worker's Compensation |
$82.17
|
|
|
PSYTX PT&/FAMILY 30 MINUT
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
CPT 90832
|
| Hospital Charge Code |
5090832
|
|
Hospital Revenue Code
|
910
|
| Min. Negotiated Rate |
$51.32 |
| Max. Negotiated Rate |
$305.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$117.48
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$112.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$117.48
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$93.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$152.56
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cigna Commercial |
$159.80
|
| Rate for Payer: First Health Commercial |
$169.20
|
| Rate for Payer: First Health Workers Compensation |
$72.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$169.20
|
| Rate for Payer: GEHA Commercial |
$150.40
|
| Rate for Payer: GEHA Medicare |
$152.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$169.20
|
| Rate for Payer: Humana ChoiceCare |
$167.82
|
| Rate for Payer: Humana Medicare Advantage |
$152.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$256.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$94.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$152.56
|
| Rate for Payer: Multiplan All |
$171.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$259.35
|
| Rate for Payer: OMNI Networks Commercial |
$131.60
|
| Rate for Payer: One Health Plan PPO/POS |
$169.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$109.65
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$94.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$152.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$178.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$305.12
|
| Rate for Payer: Three Rivers Provider Network All |
$141.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$149.51
|
| Rate for Payer: United Healthcare Managed Medicaid |
$94.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$152.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$174.84
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$152.56
|
| Rate for Payer: Zelis Auto |
$75.20
|
| Rate for Payer: Zelis Medicare |
$129.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$183.07
|
| Rate for Payer: Zelis Worker's Compensation |
$51.32
|
|
|
PSYTX PT&/FAMILY 30 MINUT
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
CPT 90832
|
| Hospital Charge Code |
5090832
|
|
Hospital Revenue Code
|
910
|
| Min. Negotiated Rate |
$51.32 |
| Max. Negotiated Rate |
$178.60 |
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cigna Commercial |
$159.80
|
| Rate for Payer: First Health Commercial |
$169.20
|
| Rate for Payer: First Health Workers Compensation |
$72.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$169.20
|
| Rate for Payer: GEHA Commercial |
$131.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$169.20
|
| Rate for Payer: Multiplan All |
$171.08
|
| Rate for Payer: OMNI Networks Commercial |
$131.60
|
| Rate for Payer: One Health Plan PPO/POS |
$169.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$178.60
|
| Rate for Payer: Three Rivers Provider Network All |
$141.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$174.84
|
| Rate for Payer: Zelis Auto |
$75.20
|
| Rate for Payer: Zelis Worker's Compensation |
$51.32
|
|
|
PSYTX PT&/FAMILY 45 MINUTE
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT 90834
|
| Hospital Charge Code |
5090834
|
|
Hospital Revenue Code
|
910
|
| Min. Negotiated Rate |
$66.61 |
| Max. Negotiated Rate |
$231.80 |
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cigna Commercial |
$207.40
|
| Rate for Payer: First Health Commercial |
$219.60
|
| Rate for Payer: First Health Workers Compensation |
$94.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$219.60
|
| Rate for Payer: GEHA Commercial |
$170.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$219.60
|
| Rate for Payer: Multiplan All |
$222.04
|
| Rate for Payer: OMNI Networks Commercial |
$170.80
|
| Rate for Payer: One Health Plan PPO/POS |
$219.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$231.80
|
| Rate for Payer: Three Rivers Provider Network All |
$183.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$226.92
|
| Rate for Payer: Zelis Auto |
$97.60
|
| Rate for Payer: Zelis Worker's Compensation |
$66.61
|
|
|
PSYTX PT&/FAMILY 45 MINUTE
|
Facility
|
OP
|
$244.00
|
|
|
Service Code
|
CPT 90834
|
| Hospital Charge Code |
5090834
|
|
Hospital Revenue Code
|
910
|
| Min. Negotiated Rate |
$66.61 |
| Max. Negotiated Rate |
$305.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$156.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$146.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$156.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$123.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$152.56
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cigna Commercial |
$207.40
|
| Rate for Payer: First Health Commercial |
$219.60
|
| Rate for Payer: First Health Workers Compensation |
$94.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$219.60
|
| Rate for Payer: GEHA Commercial |
$195.20
|
| Rate for Payer: GEHA Medicare |
$152.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$219.60
|
| Rate for Payer: Humana ChoiceCare |
$167.82
|
| Rate for Payer: Humana Medicare Advantage |
$152.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$256.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$126.26
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$152.56
|
| Rate for Payer: Multiplan All |
$222.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$259.35
|
| Rate for Payer: OMNI Networks Commercial |
$170.80
|
| Rate for Payer: One Health Plan PPO/POS |
$219.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$145.78
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$126.26
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$152.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$231.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$305.12
|
| Rate for Payer: Three Rivers Provider Network All |
$183.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$149.51
|
| Rate for Payer: United Healthcare Managed Medicaid |
$126.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$152.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$226.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$152.56
|
| Rate for Payer: Zelis Auto |
$97.60
|
| Rate for Payer: Zelis Medicare |
$129.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$183.07
|
| Rate for Payer: Zelis Worker's Compensation |
$66.61
|
|
|
PSYTX PT&/FAMILY 60 MINUTE
|
Facility
|
OP
|
$370.00
|
|
|
Service Code
|
CPT 90837
|
| Hospital Charge Code |
5090837
|
|
Hospital Revenue Code
|
910
|
| Min. Negotiated Rate |
$101.01 |
| Max. Negotiated Rate |
$351.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$156.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$222.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$156.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$123.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$152.56
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cigna Commercial |
$314.50
|
| Rate for Payer: First Health Commercial |
$333.00
|
| Rate for Payer: First Health Workers Compensation |
$142.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$333.00
|
| Rate for Payer: GEHA Commercial |
$296.00
|
| Rate for Payer: GEHA Medicare |
$152.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$333.00
|
| Rate for Payer: Humana ChoiceCare |
$167.82
|
| Rate for Payer: Humana Medicare Advantage |
$152.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$256.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$126.26
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$152.56
|
| Rate for Payer: Multiplan All |
$336.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$259.35
|
| Rate for Payer: OMNI Networks Commercial |
$259.00
|
| Rate for Payer: One Health Plan PPO/POS |
$333.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$145.78
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$126.26
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$152.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$351.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$305.12
|
| Rate for Payer: Three Rivers Provider Network All |
$277.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$149.51
|
| Rate for Payer: United Healthcare Managed Medicaid |
$126.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$152.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$344.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$152.56
|
| Rate for Payer: Zelis Auto |
$148.00
|
| Rate for Payer: Zelis Medicare |
$129.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$183.07
|
| Rate for Payer: Zelis Worker's Compensation |
$101.01
|
|
|
PSYTX PT&/FAMILY 60 MINUTE
|
Facility
|
IP
|
$370.00
|
|
|
Service Code
|
CPT 90837
|
| Hospital Charge Code |
5090837
|
|
Hospital Revenue Code
|
910
|
| Min. Negotiated Rate |
$101.01 |
| Max. Negotiated Rate |
$351.50 |
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cigna Commercial |
$314.50
|
| Rate for Payer: First Health Commercial |
$333.00
|
| Rate for Payer: First Health Workers Compensation |
$142.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$333.00
|
| Rate for Payer: GEHA Commercial |
$259.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$333.00
|
| Rate for Payer: Multiplan All |
$336.70
|
| Rate for Payer: OMNI Networks Commercial |
$259.00
|
| Rate for Payer: One Health Plan PPO/POS |
$333.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$351.50
|
| Rate for Payer: Three Rivers Provider Network All |
$277.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$344.10
|
| Rate for Payer: Zelis Auto |
$148.00
|
| Rate for Payer: Zelis Worker's Compensation |
$101.01
|
|
|
PSYTX PT&/FAM W/E&M 30 MI
|
Facility
|
OP
|
$193.00
|
|
|
Service Code
|
CPT 90833
|
| Hospital Charge Code |
5090833
|
|
Hospital Revenue Code
|
910
|
| Min. Negotiated Rate |
$48.64 |
| Max. Negotiated Rate |
$183.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$61.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$115.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$61.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$48.64
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cigna Commercial |
$164.05
|
| Rate for Payer: First Health Commercial |
$173.70
|
| Rate for Payer: First Health Workers Compensation |
$74.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$173.70
|
| Rate for Payer: GEHA Commercial |
$154.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$173.70
|
| Rate for Payer: Humana ChoiceCare |
$50.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$49.63
|
| Rate for Payer: Multiplan All |
$175.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$115.80
|
| Rate for Payer: OMNI Networks Commercial |
$135.10
|
| Rate for Payer: One Health Plan PPO/POS |
$173.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$57.30
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$49.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$183.35
|
| Rate for Payer: Three Rivers Provider Network All |
$144.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$169.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$49.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$179.49
|
| Rate for Payer: Zelis Auto |
$77.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$96.50
|
| Rate for Payer: Zelis Worker's Compensation |
$52.69
|
|
|
PSYTX PT&/FAM W/E&M 30 MI
|
Facility
|
IP
|
$193.00
|
|
|
Service Code
|
CPT 90833
|
| Hospital Charge Code |
5090833
|
|
Hospital Revenue Code
|
910
|
| Min. Negotiated Rate |
$52.69 |
| Max. Negotiated Rate |
$183.35 |
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cigna Commercial |
$164.05
|
| Rate for Payer: First Health Commercial |
$173.70
|
| Rate for Payer: First Health Workers Compensation |
$74.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$173.70
|
| Rate for Payer: GEHA Commercial |
$135.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$173.70
|
| Rate for Payer: Multiplan All |
$175.63
|
| Rate for Payer: OMNI Networks Commercial |
$135.10
|
| Rate for Payer: One Health Plan PPO/POS |
$173.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$183.35
|
| Rate for Payer: Three Rivers Provider Network All |
$144.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$179.49
|
| Rate for Payer: Zelis Auto |
$77.20
|
| Rate for Payer: Zelis Worker's Compensation |
$52.69
|
|
|
PSYTX PT&/FAM W/E&M 45 MI
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT 90836
|
| Hospital Charge Code |
5090836
|
|
Hospital Revenue Code
|
910
|
| Min. Negotiated Rate |
$66.61 |
| Max. Negotiated Rate |
$231.80 |
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cigna Commercial |
$207.40
|
| Rate for Payer: First Health Commercial |
$219.60
|
| Rate for Payer: First Health Workers Compensation |
$94.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$219.60
|
| Rate for Payer: GEHA Commercial |
$170.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$219.60
|
| Rate for Payer: Multiplan All |
$222.04
|
| Rate for Payer: OMNI Networks Commercial |
$170.80
|
| Rate for Payer: One Health Plan PPO/POS |
$219.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$231.80
|
| Rate for Payer: Three Rivers Provider Network All |
$183.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$226.92
|
| Rate for Payer: Zelis Auto |
$97.60
|
| Rate for Payer: Zelis Worker's Compensation |
$66.61
|
|
