|
PSYTX PT&/FAM W/E&M 45 MI
|
Facility
|
OP
|
$244.00
|
|
|
Service Code
|
CPT 90836
|
| Hospital Charge Code |
5090836
|
|
Hospital Revenue Code
|
910
|
| Min. Negotiated Rate |
$63.44 |
| Max. Negotiated Rate |
$231.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$99.66
|
| 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 |
$99.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$78.95
|
| 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: Great West Healthcare (Cigna) Commercial |
$219.60
|
| Rate for Payer: Humana ChoiceCare |
$63.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$80.56
|
| Rate for Payer: Multiplan All |
$222.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$146.40
|
| 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 |
$93.02
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$80.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$231.80
|
| Rate for Payer: Three Rivers Provider Network All |
$183.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$214.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$80.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$226.92
|
| Rate for Payer: Zelis Auto |
$97.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$122.00
|
| Rate for Payer: Zelis Worker's Compensation |
$66.61
|
|
|
PSYTX PT&/FAM W/E&M 60 MI
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
CPT 90838
|
| Hospital Charge Code |
5090838
|
|
Hospital Revenue Code
|
910
|
| Min. Negotiated Rate |
$87.36 |
| Max. Negotiated Rate |
$304.00 |
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cigna Commercial |
$272.00
|
| Rate for Payer: First Health Commercial |
$288.00
|
| Rate for Payer: First Health Workers Compensation |
$123.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$288.00
|
| Rate for Payer: GEHA Commercial |
$224.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$288.00
|
| Rate for Payer: Multiplan All |
$291.20
|
| Rate for Payer: OMNI Networks Commercial |
$224.00
|
| Rate for Payer: One Health Plan PPO/POS |
$288.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$304.00
|
| Rate for Payer: Three Rivers Provider Network All |
$240.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$297.60
|
| Rate for Payer: Zelis Auto |
$128.00
|
| Rate for Payer: Zelis Worker's Compensation |
$87.36
|
|
|
PSYTX PT&/FAM W/E&M 60 MI
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
CPT 90838
|
| Hospital Charge Code |
5090838
|
|
Hospital Revenue Code
|
910
|
| Min. Negotiated Rate |
$83.20 |
| Max. Negotiated Rate |
$304.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$148.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$192.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$148.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.38
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cigna Commercial |
$272.00
|
| Rate for Payer: First Health Commercial |
$288.00
|
| Rate for Payer: First Health Workers Compensation |
$123.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$288.00
|
| Rate for Payer: GEHA Commercial |
$256.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$288.00
|
| Rate for Payer: Humana ChoiceCare |
$83.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.77
|
| Rate for Payer: Multiplan All |
$291.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$192.00
|
| Rate for Payer: OMNI Networks Commercial |
$224.00
|
| Rate for Payer: One Health Plan PPO/POS |
$288.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$138.29
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.77
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$304.00
|
| Rate for Payer: Three Rivers Provider Network All |
$240.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$281.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.77
|
| Rate for Payer: United Payors & United Providers UP&UP |
$297.60
|
| Rate for Payer: Zelis Auto |
$128.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$160.00
|
| Rate for Payer: Zelis Worker's Compensation |
$87.36
|
|
|
PTA ADL TRNG
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
CPT 97535 GP,CQ
|
| Hospital Charge Code |
4397535
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$45.05 |
| Max. Negotiated Rate |
$156.75 |
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$140.25
|
| Rate for Payer: First Health Commercial |
$148.50
|
| Rate for Payer: First Health Workers Compensation |
$63.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$148.50
|
| Rate for Payer: GEHA Commercial |
$115.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$148.50
|
| Rate for Payer: Multiplan All |
$150.15
|
| Rate for Payer: OMNI Networks Commercial |
$115.50
|
| Rate for Payer: One Health Plan PPO/POS |
$148.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$156.75
|
| Rate for Payer: Three Rivers Provider Network All |
$123.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$153.45
|
| Rate for Payer: Zelis Auto |
$66.00
|
| Rate for Payer: Zelis Worker's Compensation |
$45.05
|
|
|
PTA ADL TRNG
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
CPT 97535 GP,CQ
|
| Hospital Charge Code |
4397535
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$42.90 |
| Max. Negotiated Rate |
$156.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$68.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$99.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$68.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$54.51
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$140.25
|
| Rate for Payer: First Health Commercial |
$148.50
|
| Rate for Payer: First Health Workers Compensation |
$61.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$148.50
|
| Rate for Payer: GEHA Commercial |
$132.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$148.50
|
| Rate for Payer: Humana ChoiceCare |
$42.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$55.62
|
| Rate for Payer: Multiplan All |
$150.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$99.00
|
| Rate for Payer: OMNI Networks Commercial |
$115.50
|
| Rate for Payer: One Health Plan PPO/POS |
$148.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$64.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$55.62
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$156.75
|
| Rate for Payer: Three Rivers Provider Network All |
$123.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$145.20
|
| Rate for Payer: United Healthcare Commercial |
$140.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$55.62
|
| Rate for Payer: United Payors & United Providers UP&UP |
$153.45
|
| Rate for Payer: Zelis Auto |
$66.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$82.50
|
| Rate for Payer: Zelis Worker's Compensation |
$43.42
|
|
|
PTA ASSISTIVE TECHNOLOGY ASSESSMENT
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT 97755 GP,CQ
|
| Hospital Charge Code |
4398014
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$52.42 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: First Health Commercial |
$172.80
|
| Rate for Payer: First Health Workers Compensation |
$74.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$172.80
|
| Rate for Payer: GEHA Commercial |
$134.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.80
|
| Rate for Payer: Multiplan All |
$174.72
|
| Rate for Payer: OMNI Networks Commercial |
$134.40
|
| Rate for Payer: One Health Plan PPO/POS |
$172.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$182.40
|
| Rate for Payer: Three Rivers Provider Network All |
$144.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$178.56
|
| Rate for Payer: Zelis Auto |
$76.80
|
| Rate for Payer: Zelis Worker's Compensation |
$52.42
|
|
|
PTA ASSISTIVE TECHNOLOGY ASSESSMENT
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT 97755 GP,CQ
|
| Hospital Charge Code |
4398014
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$40.65 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$51.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$115.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$51.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$40.65
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: First Health Commercial |
$172.80
|
| Rate for Payer: First Health Workers Compensation |
$73.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$172.80
|
| Rate for Payer: GEHA Commercial |
$153.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.80
|
| Rate for Payer: Humana ChoiceCare |
$49.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$41.48
|
| Rate for Payer: Multiplan All |
$174.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$115.20
|
| Rate for Payer: OMNI Networks Commercial |
$134.40
|
| Rate for Payer: One Health Plan PPO/POS |
$172.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$47.89
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$41.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$182.40
|
| Rate for Payer: Three Rivers Provider Network All |
$144.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$168.96
|
| Rate for Payer: United Healthcare Commercial |
$163.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$41.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$178.56
|
| Rate for Payer: Zelis Auto |
$76.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$96.00
|
| Rate for Payer: Zelis Worker's Compensation |
$51.83
|
|
|
PTA BIOFEEDBACK TRAIN, ANY ME
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
CPT 90901 GP,CQ
|
| Hospital Charge Code |
4398000
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$26.50 |
| Max. Negotiated Rate |
$100.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$63.60
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$90.10
|
| Rate for Payer: First Health Commercial |
$95.40
|
| Rate for Payer: First Health Workers Compensation |
$76.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$95.40
|
| Rate for Payer: GEHA Commercial |
$84.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$95.40
|
| Rate for Payer: Humana ChoiceCare |
$27.56
|
| Rate for Payer: Multiplan All |
$96.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$63.60
|
| Rate for Payer: OMNI Networks Commercial |
$74.20
|
| Rate for Payer: One Health Plan PPO/POS |
$95.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$100.70
|
| Rate for Payer: Three Rivers Provider Network All |
$79.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$93.28
|
| Rate for Payer: United Healthcare Commercial |
$90.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$26.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$98.58
|
| Rate for Payer: Zelis Auto |
$42.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$53.00
|
| Rate for Payer: Zelis Worker's Compensation |
$54.16
|
|
|
PTA BIOFEEDBACK TRAIN, ANY ME
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 90901 GP,CQ
|
| Hospital Charge Code |
4398000
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$28.94 |
| Max. Negotiated Rate |
$100.70 |
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$90.10
|
| Rate for Payer: First Health Commercial |
$95.40
|
| Rate for Payer: First Health Workers Compensation |
$40.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$95.40
|
| Rate for Payer: GEHA Commercial |
$74.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$95.40
|
| Rate for Payer: Multiplan All |
$96.46
|
| Rate for Payer: OMNI Networks Commercial |
$74.20
|
| Rate for Payer: One Health Plan PPO/POS |
$95.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$100.70
|
| Rate for Payer: Three Rivers Provider Network All |
$79.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$98.58
|
| Rate for Payer: Zelis Auto |
$42.40
|
| Rate for Payer: Zelis Worker's Compensation |
$28.94
|
|
|
PTA COMM WORK REINT
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT 97537 GP,CQ
|
| Hospital Charge Code |
4397537
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$31.63 |
| Max. Negotiated Rate |
$115.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$39.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$73.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$39.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$31.63
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$103.70
|
| Rate for Payer: First Health Commercial |
$109.80
|
| Rate for Payer: First Health Workers Compensation |
$60.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$109.80
|
| Rate for Payer: GEHA Commercial |
$97.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$109.80
|
| Rate for Payer: Humana ChoiceCare |
$31.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$32.28
|
| Rate for Payer: Multiplan All |
$111.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$73.20
|
| Rate for Payer: OMNI Networks Commercial |
$85.40
|
| Rate for Payer: One Health Plan PPO/POS |
$109.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$37.27
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$32.28
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$115.90
|
| Rate for Payer: Three Rivers Provider Network All |
$91.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$107.36
|
| Rate for Payer: United Healthcare Commercial |
$103.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$32.28
|
| Rate for Payer: United Payors & United Providers UP&UP |
$113.46
|
| Rate for Payer: Zelis Auto |
$48.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$61.00
|
| Rate for Payer: Zelis Worker's Compensation |
$42.49
|
|
|
PTA COMM WORK REINT
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT 97537 GP,CQ
|
| Hospital Charge Code |
4397537
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$33.31 |
| Max. Negotiated Rate |
$115.90 |
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$103.70
|
| Rate for Payer: First Health Commercial |
$109.80
|
| Rate for Payer: First Health Workers Compensation |
$47.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$109.80
|
| Rate for Payer: GEHA Commercial |
$85.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$109.80
|
| Rate for Payer: Multiplan All |
$111.02
|
| Rate for Payer: OMNI Networks Commercial |
$85.40
|
| Rate for Payer: One Health Plan PPO/POS |
$109.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$115.90
|
| Rate for Payer: Three Rivers Provider Network All |
$91.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$113.46
|
| Rate for Payer: Zelis Auto |
$48.80
|
| Rate for Payer: Zelis Worker's Compensation |
$33.31
|
|
|
PTA CONTRAST BATH
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
CPT 97034 GP,CQ
|
| Hospital Charge Code |
4397034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$35.49 |
| Max. Negotiated Rate |
$123.50 |
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$110.50
|
| Rate for Payer: First Health Commercial |
$117.00
|
| Rate for Payer: First Health Workers Compensation |
$50.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$117.00
|
| Rate for Payer: GEHA Commercial |
$91.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$117.00
|
| Rate for Payer: Multiplan All |
$118.30
|
| Rate for Payer: OMNI Networks Commercial |
$91.00
|
| Rate for Payer: One Health Plan PPO/POS |
$117.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$123.50
|
| Rate for Payer: Three Rivers Provider Network All |
$97.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$120.90
|
| Rate for Payer: Zelis Auto |
$52.00
|
| Rate for Payer: Zelis Worker's Compensation |
$35.49
|
|
|
PTA CONTRAST BATH
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
CPT 97034 GP,CQ
|
| Hospital Charge Code |
4397034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.68 |
| Max. Negotiated Rate |
$123.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$29.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$78.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$29.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$23.54
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$110.50
|
| Rate for Payer: First Health Commercial |
$117.00
|
| Rate for Payer: First Health Workers Compensation |
$26.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$117.00
|
| Rate for Payer: GEHA Commercial |
$104.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$117.00
|
| Rate for Payer: Humana ChoiceCare |
$33.80
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24.02
|
| Rate for Payer: Multiplan All |
$118.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$78.00
|
| Rate for Payer: OMNI Networks Commercial |
$91.00
|
| Rate for Payer: One Health Plan PPO/POS |
$117.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$27.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$24.02
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$123.50
|
| Rate for Payer: Three Rivers Provider Network All |
$97.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$114.40
|
| Rate for Payer: United Healthcare Commercial |
$110.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.02
|
| Rate for Payer: United Payors & United Providers UP&UP |
$120.90
|
| Rate for Payer: Zelis Auto |
$52.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$65.00
|
| Rate for Payer: Zelis Worker's Compensation |
$18.68
|
|
|
PTA CPM SET UP
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 97039 GP,CQ
|
| Hospital Charge Code |
4397093
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.52 |
| Max. Negotiated Rate |
$108.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$22.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$68.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$22.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$17.52
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna Commercial |
$96.90
|
| Rate for Payer: First Health Commercial |
$102.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$102.60
|
| Rate for Payer: GEHA Commercial |
$91.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$102.60
|
| Rate for Payer: Humana ChoiceCare |
$29.64
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$17.87
|
| Rate for Payer: Multiplan All |
$103.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$68.40
|
| Rate for Payer: OMNI Networks Commercial |
$79.80
|
| Rate for Payer: One Health Plan PPO/POS |
$102.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$20.64
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$17.87
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$108.30
|
| Rate for Payer: Three Rivers Provider Network All |
$85.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$100.32
|
| Rate for Payer: United Healthcare Commercial |
$96.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17.87
|
| Rate for Payer: United Payors & United Providers UP&UP |
$106.02
|
| Rate for Payer: Zelis Auto |
$45.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$57.00
|
|
|
PTA CPM SET UP
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 97039 GP,CQ
|
| Hospital Charge Code |
4397093
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$31.12 |
| Max. Negotiated Rate |
$108.30 |
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna Commercial |
$96.90
|
| Rate for Payer: First Health Commercial |
$102.60
|
| Rate for Payer: First Health Workers Compensation |
$44.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$102.60
|
| Rate for Payer: GEHA Commercial |
$79.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$102.60
|
| Rate for Payer: Multiplan All |
$103.74
|
| Rate for Payer: OMNI Networks Commercial |
$79.80
|
| Rate for Payer: One Health Plan PPO/POS |
$102.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$108.30
|
| Rate for Payer: Three Rivers Provider Network All |
$85.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$106.02
|
| Rate for Payer: Zelis Auto |
$45.60
|
| Rate for Payer: Zelis Worker's Compensation |
$31.12
|
|
|
PTA DEBRIDEMENT ADDL 20 CM
|
Facility
|
IP
|
$369.00
|
|
|
Service Code
|
CPT 97598 GP,CQ
|
| Hospital Charge Code |
4397598
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$100.74 |
| Max. Negotiated Rate |
$350.55 |
| Rate for Payer: Cash Price |
$221.40
|
| Rate for Payer: Cigna Commercial |
$313.65
|
| Rate for Payer: First Health Commercial |
$332.10
|
| Rate for Payer: First Health Workers Compensation |
$142.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$332.10
|
| Rate for Payer: GEHA Commercial |
$258.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$332.10
|
| Rate for Payer: Multiplan All |
$335.79
|
| Rate for Payer: OMNI Networks Commercial |
$258.30
|
| Rate for Payer: One Health Plan PPO/POS |
$332.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$350.55
|
| Rate for Payer: Three Rivers Provider Network All |
$276.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$343.17
|
| Rate for Payer: Zelis Auto |
$147.60
|
| Rate for Payer: Zelis Worker's Compensation |
$100.74
|
|
|
PTA DEBRIDEMENT ADDL 20 CM
|
Facility
|
OP
|
$369.00
|
|
|
Service Code
|
CPT 97598 GP,CQ
|
| Hospital Charge Code |
4397598
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$60.23 |
| Max. Negotiated Rate |
$350.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$221.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$123.45
|
| Rate for Payer: Cash Price |
$221.40
|
| Rate for Payer: Cash Price |
$221.40
|
| Rate for Payer: Cigna Commercial |
$313.65
|
| Rate for Payer: First Health Commercial |
$332.10
|
| Rate for Payer: First Health Workers Compensation |
$85.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$332.10
|
| Rate for Payer: GEHA Commercial |
$295.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$332.10
|
| Rate for Payer: Humana ChoiceCare |
$95.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$125.97
|
| Rate for Payer: Multiplan All |
$335.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$221.40
|
| Rate for Payer: OMNI Networks Commercial |
$258.30
|
| Rate for Payer: One Health Plan PPO/POS |
$332.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$145.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$125.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$350.55
|
| Rate for Payer: Three Rivers Provider Network All |
$276.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$324.72
|
| Rate for Payer: United Healthcare Commercial |
$313.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$125.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$343.17
|
| Rate for Payer: Zelis Auto |
$147.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$184.50
|
| Rate for Payer: Zelis Worker's Compensation |
$60.23
|
|
|
PTA DEVELOPMENTAL SCREENING
|
Facility
|
IP
|
$380.00
|
|
|
Service Code
|
CPT 96110 GP,CQ
|
| Hospital Charge Code |
4398006
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$103.74 |
| Max. Negotiated Rate |
$361.00 |
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$323.00
|
| Rate for Payer: First Health Commercial |
$342.00
|
| Rate for Payer: First Health Workers Compensation |
$146.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$342.00
|
| Rate for Payer: GEHA Commercial |
$266.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$342.00
|
| Rate for Payer: Multiplan All |
$345.80
|
| Rate for Payer: OMNI Networks Commercial |
$266.00
|
| Rate for Payer: One Health Plan PPO/POS |
$342.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$361.00
|
| Rate for Payer: Three Rivers Provider Network All |
$285.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$353.40
|
| Rate for Payer: Zelis Auto |
$152.00
|
| Rate for Payer: Zelis Worker's Compensation |
$103.74
|
|
|
PTA DEVELOPMENTAL SCREENING
|
Facility
|
OP
|
$380.00
|
|
|
Service Code
|
CPT 96110 GP,CQ
|
| Hospital Charge Code |
4398006
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$14.32 |
| Max. Negotiated Rate |
$361.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$18.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$228.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$18.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$14.32
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$323.00
|
| Rate for Payer: First Health Commercial |
$342.00
|
| Rate for Payer: First Health Workers Compensation |
$21.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$342.00
|
| Rate for Payer: GEHA Commercial |
$304.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$342.00
|
| Rate for Payer: Humana ChoiceCare |
$98.80
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$14.61
|
| Rate for Payer: Multiplan All |
$345.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$228.00
|
| Rate for Payer: OMNI Networks Commercial |
$266.00
|
| Rate for Payer: One Health Plan PPO/POS |
$342.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$16.87
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$14.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$361.00
|
| Rate for Payer: Three Rivers Provider Network All |
$285.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$334.40
|
| Rate for Payer: United Healthcare Commercial |
$323.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$353.40
|
| Rate for Payer: Zelis Auto |
$152.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$190.00
|
| Rate for Payer: Zelis Worker's Compensation |
$15.54
|
|
|
PTA ELEC STIM CONST ATTE
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT 97032 GP,CQ
|
| Hospital Charge Code |
4397032
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$45.32 |
| Max. Negotiated Rate |
$157.70 |
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cigna Commercial |
$141.10
|
| Rate for Payer: First Health Commercial |
$149.40
|
| Rate for Payer: First Health Workers Compensation |
$64.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$149.40
|
| Rate for Payer: GEHA Commercial |
$116.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$149.40
|
| Rate for Payer: Multiplan All |
$151.06
|
| Rate for Payer: OMNI Networks Commercial |
$116.20
|
| Rate for Payer: One Health Plan PPO/POS |
$149.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$157.70
|
| Rate for Payer: Three Rivers Provider Network All |
$124.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$154.38
|
| Rate for Payer: Zelis Auto |
$66.40
|
| Rate for Payer: Zelis Worker's Compensation |
$45.32
|
|
|
PTA ELEC STIM CONST ATTE
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT 97032 GP,CQ
|
| Hospital Charge Code |
4397032
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.61 |
| Max. Negotiated Rate |
$157.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$30.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$99.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$30.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$24.29
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cigna Commercial |
$141.10
|
| Rate for Payer: First Health Commercial |
$149.40
|
| Rate for Payer: First Health Workers Compensation |
$27.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$149.40
|
| Rate for Payer: GEHA Commercial |
$132.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$149.40
|
| Rate for Payer: Humana ChoiceCare |
$43.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24.78
|
| Rate for Payer: Multiplan All |
$151.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$99.60
|
| Rate for Payer: OMNI Networks Commercial |
$116.20
|
| Rate for Payer: One Health Plan PPO/POS |
$149.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$28.62
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$24.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$157.70
|
| Rate for Payer: Three Rivers Provider Network All |
$124.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$146.08
|
| Rate for Payer: United Healthcare Commercial |
$141.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$154.38
|
| Rate for Payer: Zelis Auto |
$66.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$83.00
|
| Rate for Payer: Zelis Worker's Compensation |
$19.61
|
|
|
PTA GAIT TRAIN EA 15 MIN
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT 97116 GP,CQ
|
| Hospital Charge Code |
4397116
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$43.68 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$136.00
|
| Rate for Payer: First Health Commercial |
$144.00
|
| Rate for Payer: First Health Workers Compensation |
$61.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$144.00
|
| Rate for Payer: GEHA Commercial |
$112.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$144.00
|
| Rate for Payer: Multiplan All |
$145.60
|
| Rate for Payer: OMNI Networks Commercial |
$112.00
|
| Rate for Payer: One Health Plan PPO/POS |
$144.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$152.00
|
| Rate for Payer: Three Rivers Provider Network All |
$120.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$148.80
|
| Rate for Payer: Zelis Auto |
$64.00
|
| Rate for Payer: Zelis Worker's Compensation |
$43.68
|
|
|
PTA GAIT TRAIN EA 15 MIN
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT 97116 GP,CQ
|
| Hospital Charge Code |
4397116
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$39.22 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$62.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$96.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$62.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$49.21
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$136.00
|
| Rate for Payer: First Health Commercial |
$144.00
|
| Rate for Payer: First Health Workers Compensation |
$55.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$144.00
|
| Rate for Payer: GEHA Commercial |
$128.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$144.00
|
| Rate for Payer: Humana ChoiceCare |
$41.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$50.21
|
| Rate for Payer: Multiplan All |
$145.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$96.00
|
| Rate for Payer: OMNI Networks Commercial |
$112.00
|
| Rate for Payer: One Health Plan PPO/POS |
$144.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$57.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$50.21
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$152.00
|
| Rate for Payer: Three Rivers Provider Network All |
$120.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$140.80
|
| Rate for Payer: United Healthcare Commercial |
$136.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$50.21
|
| Rate for Payer: United Payors & United Providers UP&UP |
$148.80
|
| Rate for Payer: Zelis Auto |
$64.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$80.00
|
| Rate for Payer: Zelis Worker's Compensation |
$39.22
|
|
|
PTA GROUP PHYS THERAPY
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 97150 GP,CQ
|
| Hospital Charge Code |
4397150
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$24.28 |
| Max. Negotiated Rate |
$145.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$38.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$91.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$38.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$30.33
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cigna Commercial |
$130.05
|
| Rate for Payer: First Health Commercial |
$137.70
|
| Rate for Payer: First Health Workers Compensation |
$34.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$137.70
|
| Rate for Payer: GEHA Commercial |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$137.70
|
| Rate for Payer: Humana ChoiceCare |
$39.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$30.94
|
| Rate for Payer: Multiplan All |
$139.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$91.80
|
| Rate for Payer: OMNI Networks Commercial |
$107.10
|
| Rate for Payer: One Health Plan PPO/POS |
$137.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$35.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$30.94
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$145.35
|
| Rate for Payer: Three Rivers Provider Network All |
$114.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$134.64
|
| Rate for Payer: United Healthcare Commercial |
$130.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$30.94
|
| Rate for Payer: United Payors & United Providers UP&UP |
$142.29
|
| Rate for Payer: Zelis Auto |
$61.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$76.50
|
| Rate for Payer: Zelis Worker's Compensation |
$24.28
|
|
|
PTA GROUP PHYS THERAPY
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 97150 GP,CQ
|
| Hospital Charge Code |
4397150
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$41.77 |
| Max. Negotiated Rate |
$145.35 |
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cigna Commercial |
$130.05
|
| Rate for Payer: First Health Commercial |
$137.70
|
| Rate for Payer: First Health Workers Compensation |
$59.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$137.70
|
| Rate for Payer: GEHA Commercial |
$107.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$137.70
|
| Rate for Payer: Multiplan All |
$139.23
|
| Rate for Payer: OMNI Networks Commercial |
$107.10
|
| Rate for Payer: One Health Plan PPO/POS |
$137.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$145.35
|
| Rate for Payer: Three Rivers Provider Network All |
$114.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$142.29
|
| Rate for Payer: Zelis Auto |
$61.20
|
| Rate for Payer: Zelis Worker's Compensation |
$41.77
|
|
