|
PTA INFRARED THERAPY
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 97026 GP,CQ
|
| Hospital Charge Code |
4398008
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$32.76 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$102.00
|
| Rate for Payer: First Health Commercial |
$108.00
|
| Rate for Payer: First Health Workers Compensation |
$46.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.00
|
| Rate for Payer: GEHA Commercial |
$84.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.00
|
| Rate for Payer: Multiplan All |
$109.20
|
| Rate for Payer: OMNI Networks Commercial |
$84.00
|
| Rate for Payer: One Health Plan PPO/POS |
$108.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.00
|
| Rate for Payer: Three Rivers Provider Network All |
$90.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$111.60
|
| Rate for Payer: Zelis Auto |
$48.00
|
| Rate for Payer: Zelis Worker's Compensation |
$32.76
|
|
|
PTA INFRARED THERAPY
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 97026 GP,CQ
|
| Hospital Charge Code |
4398008
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$8.87 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$13.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$72.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$13.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$11.07
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$102.00
|
| Rate for Payer: First Health Commercial |
$108.00
|
| Rate for Payer: First Health Workers Compensation |
$12.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.00
|
| Rate for Payer: GEHA Commercial |
$96.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.00
|
| Rate for Payer: Humana ChoiceCare |
$31.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$11.30
|
| Rate for Payer: Multiplan All |
$109.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$72.00
|
| Rate for Payer: OMNI Networks Commercial |
$84.00
|
| Rate for Payer: One Health Plan PPO/POS |
$108.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$13.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$11.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.00
|
| Rate for Payer: Three Rivers Provider Network All |
$90.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$105.60
|
| Rate for Payer: United Healthcare Commercial |
$102.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$11.30
|
| Rate for Payer: United Payors & United Providers UP&UP |
$111.60
|
| Rate for Payer: Zelis Auto |
$48.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$60.00
|
| Rate for Payer: Zelis Worker's Compensation |
$8.87
|
|
|
PTA IONTOPHORESIS EA 15
|
Facility
|
IP
|
$1,547.00
|
|
|
Service Code
|
CPT 97033 GP,CQ
|
| Hospital Charge Code |
4397033
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$422.33 |
| Max. Negotiated Rate |
$1,469.65 |
| Rate for Payer: Cash Price |
$928.20
|
| Rate for Payer: Cigna Commercial |
$1,314.95
|
| Rate for Payer: First Health Commercial |
$1,392.30
|
| Rate for Payer: First Health Workers Compensation |
$597.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,392.30
|
| Rate for Payer: GEHA Commercial |
$1,082.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,392.30
|
| Rate for Payer: Multiplan All |
$1,407.77
|
| Rate for Payer: OMNI Networks Commercial |
$1,082.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,392.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,469.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,160.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,438.71
|
| Rate for Payer: Zelis Auto |
$618.80
|
| Rate for Payer: Zelis Worker's Compensation |
$422.33
|
|
|
PTA IONTOPHORESIS EA 15
|
Facility
|
OP
|
$1,547.00
|
|
|
Service Code
|
CPT 97033 GP,CQ
|
| Hospital Charge Code |
4397033
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$25.68 |
| Max. Negotiated Rate |
$1,469.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$40.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$928.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$40.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$32.29
|
| Rate for Payer: Cash Price |
$928.20
|
| Rate for Payer: Cash Price |
$928.20
|
| Rate for Payer: Cigna Commercial |
$1,314.95
|
| Rate for Payer: First Health Commercial |
$1,392.30
|
| Rate for Payer: First Health Workers Compensation |
$36.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,392.30
|
| Rate for Payer: GEHA Commercial |
$1,237.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,392.30
|
| Rate for Payer: Humana ChoiceCare |
$402.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$32.94
|
| Rate for Payer: Multiplan All |
$1,407.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$928.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,082.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,392.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$38.04
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$32.94
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,469.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,160.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,361.36
|
| Rate for Payer: United Healthcare Commercial |
$1,314.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$32.94
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,438.71
|
| Rate for Payer: Zelis Auto |
$618.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$773.50
|
| Rate for Payer: Zelis Worker's Compensation |
$25.68
|
|
|
PTA LOW FREQ NON THERMAL US
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
CPT 97610 GP,CQ
|
| Hospital Charge Code |
4397610
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$92.30 |
| Max. Negotiated Rate |
$771.92 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$116.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$234.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$116.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$92.30
|
| Rate for Payer: Cash Price |
$234.60
|
| Rate for Payer: Cash Price |
$234.60
|
| Rate for Payer: Cigna Commercial |
$332.35
|
| Rate for Payer: First Health Commercial |
$351.90
|
| Rate for Payer: First Health Workers Compensation |
$771.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$351.90
|
| Rate for Payer: GEHA Commercial |
$312.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$351.90
|
| Rate for Payer: Humana ChoiceCare |
$101.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$94.17
|
| Rate for Payer: Multiplan All |
$355.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$234.60
|
| Rate for Payer: OMNI Networks Commercial |
$273.70
|
| Rate for Payer: One Health Plan PPO/POS |
$351.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$108.74
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$94.17
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$371.45
|
| Rate for Payer: Three Rivers Provider Network All |
$293.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$344.08
|
| Rate for Payer: United Healthcare Commercial |
$332.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$94.17
|
| Rate for Payer: United Payors & United Providers UP&UP |
$363.63
|
| Rate for Payer: Zelis Auto |
$156.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$195.50
|
| Rate for Payer: Zelis Worker's Compensation |
$545.80
|
|
|
PTA LOW FREQ NON THERMAL US
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
CPT 97610 GP,CQ
|
| Hospital Charge Code |
4397610
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$106.74 |
| Max. Negotiated Rate |
$371.45 |
| Rate for Payer: Cash Price |
$234.60
|
| Rate for Payer: Cigna Commercial |
$332.35
|
| Rate for Payer: First Health Commercial |
$351.90
|
| Rate for Payer: First Health Workers Compensation |
$150.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$351.90
|
| Rate for Payer: GEHA Commercial |
$273.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$351.90
|
| Rate for Payer: Multiplan All |
$355.81
|
| Rate for Payer: OMNI Networks Commercial |
$273.70
|
| Rate for Payer: One Health Plan PPO/POS |
$351.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$371.45
|
| Rate for Payer: Three Rivers Provider Network All |
$293.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$363.63
|
| Rate for Payer: Zelis Auto |
$156.40
|
| Rate for Payer: Zelis Worker's Compensation |
$106.74
|
|
|
PTA MANUAL THERAPY
|
Facility
|
OP
|
$174.00
|
|
|
Service Code
|
CPT 97140 GP,CQ
|
| Hospital Charge Code |
4397140
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$36.42 |
| Max. Negotiated Rate |
$165.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$57.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$104.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$57.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$45.39
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna Commercial |
$147.90
|
| Rate for Payer: First Health Commercial |
$156.60
|
| Rate for Payer: First Health Workers Compensation |
$51.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$156.60
|
| Rate for Payer: GEHA Commercial |
$139.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$156.60
|
| Rate for Payer: Humana ChoiceCare |
$45.24
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$46.32
|
| Rate for Payer: Multiplan All |
$158.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$104.40
|
| Rate for Payer: OMNI Networks Commercial |
$121.80
|
| Rate for Payer: One Health Plan PPO/POS |
$156.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$53.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$46.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$165.30
|
| Rate for Payer: Three Rivers Provider Network All |
$130.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$153.12
|
| Rate for Payer: United Healthcare Commercial |
$147.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$46.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$161.82
|
| Rate for Payer: Zelis Auto |
$69.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$87.00
|
| Rate for Payer: Zelis Worker's Compensation |
$36.42
|
|
|
PTA MANUAL THERAPY
|
Facility
|
IP
|
$174.00
|
|
|
Service Code
|
CPT 97140 GP,CQ
|
| Hospital Charge Code |
4397140
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$47.50 |
| Max. Negotiated Rate |
$165.30 |
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna Commercial |
$147.90
|
| Rate for Payer: First Health Commercial |
$156.60
|
| Rate for Payer: First Health Workers Compensation |
$67.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$156.60
|
| Rate for Payer: GEHA Commercial |
$121.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$156.60
|
| Rate for Payer: Multiplan All |
$158.34
|
| Rate for Payer: OMNI Networks Commercial |
$121.80
|
| Rate for Payer: One Health Plan PPO/POS |
$156.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$165.30
|
| Rate for Payer: Three Rivers Provider Network All |
$130.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$161.82
|
| Rate for Payer: Zelis Auto |
$69.60
|
| Rate for Payer: Zelis Worker's Compensation |
$47.50
|
|
|
PTA MECHANICAL TRACTION
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT 97012 GP,CQ
|
| Hospital Charge Code |
4397012
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$37.40 |
| Max. Negotiated Rate |
$130.15 |
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$116.45
|
| Rate for Payer: First Health Commercial |
$123.30
|
| Rate for Payer: First Health Workers Compensation |
$52.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$123.30
|
| Rate for Payer: GEHA Commercial |
$95.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$123.30
|
| Rate for Payer: Multiplan All |
$124.67
|
| Rate for Payer: OMNI Networks Commercial |
$95.90
|
| Rate for Payer: One Health Plan PPO/POS |
$123.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$130.15
|
| Rate for Payer: Three Rivers Provider Network All |
$102.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$127.41
|
| Rate for Payer: Zelis Auto |
$54.80
|
| Rate for Payer: Zelis Worker's Compensation |
$37.40
|
|
|
PTA MECHANICAL TRACTION
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT 97012 GP,CQ
|
| Hospital Charge Code |
4397012
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.16 |
| Max. Negotiated Rate |
$130.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$21.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$82.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$21.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$17.16
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$116.45
|
| Rate for Payer: First Health Commercial |
$123.30
|
| Rate for Payer: First Health Workers Compensation |
$27.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$123.30
|
| Rate for Payer: GEHA Commercial |
$109.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$123.30
|
| Rate for Payer: Humana ChoiceCare |
$35.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$17.51
|
| Rate for Payer: Multiplan All |
$124.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$82.20
|
| Rate for Payer: OMNI Networks Commercial |
$95.90
|
| Rate for Payer: One Health Plan PPO/POS |
$123.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$20.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$17.51
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$130.15
|
| Rate for Payer: Three Rivers Provider Network All |
$102.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$120.56
|
| Rate for Payer: United Healthcare Commercial |
$116.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17.51
|
| Rate for Payer: United Payors & United Providers UP&UP |
$127.41
|
| Rate for Payer: Zelis Auto |
$54.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$68.50
|
| Rate for Payer: Zelis Worker's Compensation |
$19.14
|
|
|
PTA MUSCLE TESTING, EXTREMITY OR TRUNK
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
CPT 95831 GP,CQ
|
| Hospital Charge Code |
4398001
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$62.24 |
| Max. Negotiated Rate |
$216.60 |
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna Commercial |
$193.80
|
| Rate for Payer: First Health Commercial |
$205.20
|
| Rate for Payer: First Health Workers Compensation |
$88.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$205.20
|
| Rate for Payer: GEHA Commercial |
$159.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$205.20
|
| Rate for Payer: Multiplan All |
$207.48
|
| Rate for Payer: OMNI Networks Commercial |
$159.60
|
| Rate for Payer: One Health Plan PPO/POS |
$205.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$216.60
|
| Rate for Payer: Three Rivers Provider Network All |
$171.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$212.04
|
| Rate for Payer: Zelis Auto |
$91.20
|
| Rate for Payer: Zelis Worker's Compensation |
$62.24
|
|
|
PTA MUSCLE TESTING, EXTREMITY OR TRUNK
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
CPT 95831 GP,CQ
|
| Hospital Charge Code |
4398001
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$216.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna Commercial |
$193.80
|
| Rate for Payer: First Health Commercial |
$205.20
|
| Rate for Payer: First Health Workers Compensation |
$88.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$205.20
|
| Rate for Payer: GEHA Commercial |
$182.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$205.20
|
| Rate for Payer: Humana ChoiceCare |
$59.28
|
| Rate for Payer: Multiplan All |
$207.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$136.80
|
| Rate for Payer: OMNI Networks Commercial |
$159.60
|
| Rate for Payer: One Health Plan PPO/POS |
$205.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$216.60
|
| Rate for Payer: Three Rivers Provider Network All |
$171.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$200.64
|
| Rate for Payer: United Healthcare Commercial |
$193.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$57.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$212.04
|
| Rate for Payer: Zelis Auto |
$91.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$114.00
|
| Rate for Payer: Zelis Worker's Compensation |
$62.24
|
|
|
PTA MUSCLE TESTING, HAND
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT 95832 GP,CQ
|
| Hospital Charge Code |
4398002
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$48.32 |
| Max. Negotiated Rate |
$168.15 |
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cigna Commercial |
$150.45
|
| Rate for Payer: First Health Commercial |
$159.30
|
| Rate for Payer: First Health Workers Compensation |
$68.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$159.30
|
| Rate for Payer: GEHA Commercial |
$123.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$159.30
|
| Rate for Payer: Multiplan All |
$161.07
|
| Rate for Payer: OMNI Networks Commercial |
$123.90
|
| Rate for Payer: One Health Plan PPO/POS |
$159.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$168.15
|
| Rate for Payer: Three Rivers Provider Network All |
$132.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$164.61
|
| Rate for Payer: Zelis Auto |
$70.80
|
| Rate for Payer: Zelis Worker's Compensation |
$48.32
|
|
|
PTA MUSCLE TESTING, HAND
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT 95832 GP,CQ
|
| Hospital Charge Code |
4398002
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$44.25 |
| Max. Negotiated Rate |
$168.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$106.20
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cigna Commercial |
$150.45
|
| Rate for Payer: First Health Commercial |
$159.30
|
| Rate for Payer: First Health Workers Compensation |
$68.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$159.30
|
| Rate for Payer: GEHA Commercial |
$141.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$159.30
|
| Rate for Payer: Humana ChoiceCare |
$46.02
|
| Rate for Payer: Multiplan All |
$161.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$106.20
|
| Rate for Payer: OMNI Networks Commercial |
$123.90
|
| Rate for Payer: One Health Plan PPO/POS |
$159.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$168.15
|
| Rate for Payer: Three Rivers Provider Network All |
$132.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$155.76
|
| Rate for Payer: United Healthcare Commercial |
$150.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$44.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$164.61
|
| Rate for Payer: Zelis Auto |
$70.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$88.50
|
| Rate for Payer: Zelis Worker's Compensation |
$48.32
|
|
|
PTA MUSCLE TESTNG, TOTAL EVALUATION OF B
|
Facility
|
IP
|
$518.00
|
|
|
Service Code
|
CPT 95833 GP,CQ
|
| Hospital Charge Code |
4398003
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$141.41 |
| Max. Negotiated Rate |
$492.10 |
| Rate for Payer: Cash Price |
$310.80
|
| Rate for Payer: Cigna Commercial |
$440.30
|
| Rate for Payer: First Health Commercial |
$466.20
|
| Rate for Payer: First Health Workers Compensation |
$200.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$466.20
|
| Rate for Payer: GEHA Commercial |
$362.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$466.20
|
| Rate for Payer: Multiplan All |
$471.38
|
| Rate for Payer: OMNI Networks Commercial |
$362.60
|
| Rate for Payer: One Health Plan PPO/POS |
$466.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$492.10
|
| Rate for Payer: Three Rivers Provider Network All |
$388.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$481.74
|
| Rate for Payer: Zelis Auto |
$207.20
|
| Rate for Payer: Zelis Worker's Compensation |
$141.41
|
|
|
PTA MUSCLE TESTNG, TOTAL EVALUATION OF B
|
Facility
|
IP
|
$354.00
|
|
|
Service Code
|
CPT 95834 GP,CQ
|
| Hospital Charge Code |
4398004
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$96.64 |
| Max. Negotiated Rate |
$336.30 |
| Rate for Payer: Cash Price |
$212.40
|
| Rate for Payer: Cigna Commercial |
$300.90
|
| Rate for Payer: First Health Commercial |
$318.60
|
| Rate for Payer: First Health Workers Compensation |
$136.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$318.60
|
| Rate for Payer: GEHA Commercial |
$247.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$318.60
|
| Rate for Payer: Multiplan All |
$322.14
|
| Rate for Payer: OMNI Networks Commercial |
$247.80
|
| Rate for Payer: One Health Plan PPO/POS |
$318.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$336.30
|
| Rate for Payer: Three Rivers Provider Network All |
$265.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$329.22
|
| Rate for Payer: Zelis Auto |
$141.60
|
| Rate for Payer: Zelis Worker's Compensation |
$96.64
|
|
|
PTA MUSCLE TESTNG, TOTAL EVALUATION OF B
|
Facility
|
OP
|
$518.00
|
|
|
Service Code
|
CPT 95833 GP,CQ
|
| Hospital Charge Code |
4398003
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$129.50 |
| Max. Negotiated Rate |
$492.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$310.80
|
| Rate for Payer: Cash Price |
$310.80
|
| Rate for Payer: Cigna Commercial |
$440.30
|
| Rate for Payer: First Health Commercial |
$466.20
|
| Rate for Payer: First Health Workers Compensation |
$200.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$466.20
|
| Rate for Payer: GEHA Commercial |
$414.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$466.20
|
| Rate for Payer: Humana ChoiceCare |
$134.68
|
| Rate for Payer: Multiplan All |
$471.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$310.80
|
| Rate for Payer: OMNI Networks Commercial |
$362.60
|
| Rate for Payer: One Health Plan PPO/POS |
$466.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$492.10
|
| Rate for Payer: Three Rivers Provider Network All |
$388.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$455.84
|
| Rate for Payer: United Healthcare Commercial |
$440.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$129.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$481.74
|
| Rate for Payer: Zelis Auto |
$207.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$259.00
|
| Rate for Payer: Zelis Worker's Compensation |
$141.41
|
|
|
PTA MUSCLE TESTNG, TOTAL EVALUATION OF B
|
Facility
|
OP
|
$354.00
|
|
|
Service Code
|
CPT 95834 GP,CQ
|
| Hospital Charge Code |
4398004
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$88.50 |
| Max. Negotiated Rate |
$336.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$212.40
|
| Rate for Payer: Cash Price |
$212.40
|
| Rate for Payer: Cigna Commercial |
$300.90
|
| Rate for Payer: First Health Commercial |
$318.60
|
| Rate for Payer: First Health Workers Compensation |
$136.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$318.60
|
| Rate for Payer: GEHA Commercial |
$283.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$318.60
|
| Rate for Payer: Humana ChoiceCare |
$92.04
|
| Rate for Payer: Multiplan All |
$322.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$212.40
|
| Rate for Payer: OMNI Networks Commercial |
$247.80
|
| Rate for Payer: One Health Plan PPO/POS |
$318.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$336.30
|
| Rate for Payer: Three Rivers Provider Network All |
$265.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$311.52
|
| Rate for Payer: United Healthcare Commercial |
$300.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$88.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$329.22
|
| Rate for Payer: Zelis Auto |
$141.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$177.00
|
| Rate for Payer: Zelis Worker's Compensation |
$96.64
|
|
|
PTA NEG PRESSURE </=50 CM
|
Facility
|
IP
|
$909.00
|
|
|
Service Code
|
CPT 97607 GP,CQ
|
| Hospital Charge Code |
4397607
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$248.16 |
| Max. Negotiated Rate |
$863.55 |
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Cigna Commercial |
$772.65
|
| Rate for Payer: First Health Commercial |
$818.10
|
| Rate for Payer: First Health Workers Compensation |
$350.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$818.10
|
| Rate for Payer: GEHA Commercial |
$636.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$818.10
|
| Rate for Payer: Multiplan All |
$827.19
|
| Rate for Payer: OMNI Networks Commercial |
$636.30
|
| Rate for Payer: One Health Plan PPO/POS |
$818.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$863.55
|
| Rate for Payer: Three Rivers Provider Network All |
$681.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$845.37
|
| Rate for Payer: Zelis Auto |
$363.60
|
| Rate for Payer: Zelis Worker's Compensation |
$248.16
|
|
|
PTA NEG PRESSURE </=50 CM
|
Facility
|
OP
|
$909.00
|
|
|
Service Code
|
CPT 97607 GP,CQ
|
| Hospital Charge Code |
4397607
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$173.59 |
| Max. Negotiated Rate |
$863.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$219.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$545.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$219.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$173.59
|
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Cigna Commercial |
$772.65
|
| Rate for Payer: First Health Commercial |
$818.10
|
| Rate for Payer: First Health Workers Compensation |
$629.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$818.10
|
| Rate for Payer: GEHA Commercial |
$727.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$818.10
|
| Rate for Payer: Humana ChoiceCare |
$236.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$177.12
|
| Rate for Payer: Multiplan All |
$827.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$545.40
|
| Rate for Payer: OMNI Networks Commercial |
$636.30
|
| Rate for Payer: One Health Plan PPO/POS |
$818.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$204.51
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$177.12
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$863.55
|
| Rate for Payer: Three Rivers Provider Network All |
$681.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$799.92
|
| Rate for Payer: United Healthcare Commercial |
$772.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$177.12
|
| Rate for Payer: United Payors & United Providers UP&UP |
$845.37
|
| Rate for Payer: Zelis Auto |
$363.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$454.50
|
| Rate for Payer: Zelis Worker's Compensation |
$445.42
|
|
|
PTA NEG PRESSURE <50CM
|
Facility
|
OP
|
$395.00
|
|
|
Service Code
|
CPT 97605 GP,CQ
|
| Hospital Charge Code |
4397605
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$56.96 |
| Max. Negotiated Rate |
$375.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$237.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cigna Commercial |
$335.75
|
| Rate for Payer: First Health Commercial |
$355.50
|
| Rate for Payer: First Health Workers Compensation |
$80.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$355.50
|
| Rate for Payer: GEHA Commercial |
$316.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$355.50
|
| Rate for Payer: Humana ChoiceCare |
$102.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Multiplan All |
$359.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$237.00
|
| Rate for Payer: OMNI Networks Commercial |
$276.50
|
| Rate for Payer: One Health Plan PPO/POS |
$355.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$375.25
|
| Rate for Payer: Three Rivers Provider Network All |
$296.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$347.60
|
| Rate for Payer: United Healthcare Commercial |
$335.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Payors & United Providers UP&UP |
$367.35
|
| Rate for Payer: Zelis Auto |
$158.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$197.50
|
| Rate for Payer: Zelis Worker's Compensation |
$56.96
|
|
|
PTA NEG PRESSURE <50CM
|
Facility
|
IP
|
$395.00
|
|
|
Service Code
|
CPT 97605 GP,CQ
|
| Hospital Charge Code |
4397605
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$107.83 |
| Max. Negotiated Rate |
$375.25 |
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cigna Commercial |
$335.75
|
| Rate for Payer: First Health Commercial |
$355.50
|
| Rate for Payer: First Health Workers Compensation |
$152.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$355.50
|
| Rate for Payer: GEHA Commercial |
$276.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$355.50
|
| Rate for Payer: Multiplan All |
$359.45
|
| Rate for Payer: OMNI Networks Commercial |
$276.50
|
| Rate for Payer: One Health Plan PPO/POS |
$355.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$375.25
|
| Rate for Payer: Three Rivers Provider Network All |
$296.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$367.35
|
| Rate for Payer: Zelis Auto |
$158.00
|
| Rate for Payer: Zelis Worker's Compensation |
$107.83
|
|
|
PTA NEG PRESSURE >50 CM
|
Facility
|
IP
|
$542.00
|
|
|
Service Code
|
CPT 97606 GP,CQ
|
| Hospital Charge Code |
4397606
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$147.97 |
| Max. Negotiated Rate |
$514.90 |
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$460.70
|
| Rate for Payer: First Health Commercial |
$487.80
|
| Rate for Payer: First Health Workers Compensation |
$209.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$487.80
|
| Rate for Payer: GEHA Commercial |
$379.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$487.80
|
| Rate for Payer: Multiplan All |
$493.22
|
| Rate for Payer: OMNI Networks Commercial |
$379.40
|
| Rate for Payer: One Health Plan PPO/POS |
$487.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$514.90
|
| Rate for Payer: Three Rivers Provider Network All |
$406.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$504.06
|
| Rate for Payer: Zelis Auto |
$216.80
|
| Rate for Payer: Zelis Worker's Compensation |
$147.97
|
|
|
PTA NEG PRESSURE >50 CM
|
Facility
|
OP
|
$542.00
|
|
|
Service Code
|
CPT 97606 GP,CQ
|
| Hospital Charge Code |
4397606
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$67.70 |
| Max. Negotiated Rate |
$514.90 |
| 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 |
$325.20
|
| 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 |
$325.20
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$460.70
|
| Rate for Payer: First Health Commercial |
$487.80
|
| Rate for Payer: First Health Workers Compensation |
$95.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$487.80
|
| Rate for Payer: GEHA Commercial |
$433.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$487.80
|
| Rate for Payer: Humana ChoiceCare |
$140.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$125.97
|
| Rate for Payer: Multiplan All |
$493.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$325.20
|
| Rate for Payer: OMNI Networks Commercial |
$379.40
|
| Rate for Payer: One Health Plan PPO/POS |
$487.80
|
| 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 |
$514.90
|
| Rate for Payer: Three Rivers Provider Network All |
$406.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$476.96
|
| Rate for Payer: United Healthcare Commercial |
$460.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$125.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$504.06
|
| Rate for Payer: Zelis Auto |
$216.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$271.00
|
| Rate for Payer: Zelis Worker's Compensation |
$67.70
|
|
|
PTA NEG PRESSURE >50CM
|
Facility
|
OP
|
$852.00
|
|
|
Service Code
|
CPT 97608 GP,CQ
|
| Hospital Charge Code |
4397608
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$221.52 |
| Max. Negotiated Rate |
$809.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$338.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$511.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$338.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$268.02
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cigna Commercial |
$724.20
|
| Rate for Payer: First Health Commercial |
$766.80
|
| Rate for Payer: First Health Workers Compensation |
$652.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$766.80
|
| Rate for Payer: GEHA Commercial |
$681.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$766.80
|
| Rate for Payer: Humana ChoiceCare |
$221.52
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$273.48
|
| Rate for Payer: Multiplan All |
$775.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$511.20
|
| Rate for Payer: OMNI Networks Commercial |
$596.40
|
| Rate for Payer: One Health Plan PPO/POS |
$766.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$315.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$273.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$809.40
|
| Rate for Payer: Three Rivers Provider Network All |
$639.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$749.76
|
| Rate for Payer: United Healthcare Commercial |
$724.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$273.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$792.36
|
| Rate for Payer: Zelis Auto |
$340.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$426.00
|
| Rate for Payer: Zelis Worker's Compensation |
$461.30
|
|
