|
PTA NEG PRESSURE >50CM
|
Facility
|
IP
|
$852.00
|
|
|
Service Code
|
CPT 97608 GP,CQ
|
| Hospital Charge Code |
4397608
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$232.60 |
| Max. Negotiated Rate |
$809.40 |
| 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 |
$328.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$766.80
|
| Rate for Payer: GEHA Commercial |
$596.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$766.80
|
| Rate for Payer: Multiplan All |
$775.32
|
| Rate for Payer: OMNI Networks Commercial |
$596.40
|
| Rate for Payer: One Health Plan PPO/POS |
$766.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$809.40
|
| Rate for Payer: Three Rivers Provider Network All |
$639.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$792.36
|
| Rate for Payer: Zelis Auto |
$340.80
|
| Rate for Payer: Zelis Worker's Compensation |
$232.60
|
|
|
PTA NEUROMUSC REED EA 15
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 97112 GP,CQ
|
| Hospital Charge Code |
4397112
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$44.72 |
| Max. Negotiated Rate |
$163.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$71.14
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$103.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$71.14
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$56.36
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cigna Commercial |
$146.20
|
| Rate for Payer: First Health Commercial |
$154.80
|
| Rate for Payer: First Health Workers Compensation |
$64.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$154.80
|
| Rate for Payer: GEHA Commercial |
$137.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$154.80
|
| Rate for Payer: Humana ChoiceCare |
$44.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$57.51
|
| Rate for Payer: Multiplan All |
$156.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$103.20
|
| Rate for Payer: OMNI Networks Commercial |
$120.40
|
| Rate for Payer: One Health Plan PPO/POS |
$154.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$66.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$57.51
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$163.40
|
| Rate for Payer: Three Rivers Provider Network All |
$129.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$151.36
|
| Rate for Payer: United Healthcare Commercial |
$146.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$57.51
|
| Rate for Payer: United Payors & United Providers UP&UP |
$159.96
|
| Rate for Payer: Zelis Auto |
$68.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$86.00
|
| Rate for Payer: Zelis Worker's Compensation |
$45.29
|
|
|
PTA NEUROMUSC REED EA 15
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 97112 GP,CQ
|
| Hospital Charge Code |
4397112
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$46.96 |
| Max. Negotiated Rate |
$163.40 |
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cigna Commercial |
$146.20
|
| Rate for Payer: First Health Commercial |
$154.80
|
| Rate for Payer: First Health Workers Compensation |
$66.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$154.80
|
| Rate for Payer: GEHA Commercial |
$120.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$154.80
|
| Rate for Payer: Multiplan All |
$156.52
|
| Rate for Payer: OMNI Networks Commercial |
$120.40
|
| Rate for Payer: One Health Plan PPO/POS |
$154.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$163.40
|
| Rate for Payer: Three Rivers Provider Network All |
$129.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$159.96
|
| Rate for Payer: Zelis Auto |
$68.80
|
| Rate for Payer: Zelis Worker's Compensation |
$46.96
|
|
|
PTA ORTHOTIC TRNG 15MIN
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT 97760 GP,CQ
|
| Hospital Charge Code |
4397760
|
|
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 ORTHOTIC TRNG 15MIN
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT 97760 GP,CQ
|
| Hospital Charge Code |
4397760
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$46.02 |
| Max. Negotiated Rate |
$168.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$99.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$106.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$99.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$78.62
|
| Rate for Payer: Cash Price |
$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 |
$89.15
|
| 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: Molina Healthcare of New Mexico Medicaid |
$80.22
|
| 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: Presbyterian Health Plan Exchange |
$92.62
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$80.22
|
| 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 |
$80.22
|
| 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 |
$63.03
|
|
|
PTA PARAFFIN BATH THERAPY
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 97018 GP,CQ
|
| Hospital Charge Code |
4397018
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$7.47 |
| Max. Negotiated Rate |
$109.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$11.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$69.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$11.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$9.48
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Cigna Commercial |
$97.75
|
| Rate for Payer: First Health Commercial |
$103.50
|
| Rate for Payer: First Health Workers Compensation |
$10.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$103.50
|
| Rate for Payer: GEHA Commercial |
$92.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$103.50
|
| Rate for Payer: Humana ChoiceCare |
$29.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$9.68
|
| Rate for Payer: Multiplan All |
$104.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$69.00
|
| Rate for Payer: OMNI Networks Commercial |
$80.50
|
| Rate for Payer: One Health Plan PPO/POS |
$103.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$11.17
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$9.68
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$109.25
|
| Rate for Payer: Three Rivers Provider Network All |
$86.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$101.20
|
| Rate for Payer: United Healthcare Commercial |
$97.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9.68
|
| Rate for Payer: United Payors & United Providers UP&UP |
$106.95
|
| Rate for Payer: Zelis Auto |
$46.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$57.50
|
| Rate for Payer: Zelis Worker's Compensation |
$7.47
|
|
|
PTA PARAFFIN BATH THERAPY
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 97018 GP,CQ
|
| Hospital Charge Code |
4397018
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$31.39 |
| Max. Negotiated Rate |
$109.25 |
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Cigna Commercial |
$97.75
|
| Rate for Payer: First Health Commercial |
$103.50
|
| Rate for Payer: First Health Workers Compensation |
$44.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$103.50
|
| Rate for Payer: GEHA Commercial |
$80.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$103.50
|
| Rate for Payer: Multiplan All |
$104.65
|
| Rate for Payer: OMNI Networks Commercial |
$80.50
|
| Rate for Payer: One Health Plan PPO/POS |
$103.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$109.25
|
| Rate for Payer: Three Rivers Provider Network All |
$86.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$106.95
|
| Rate for Payer: Zelis Auto |
$46.00
|
| Rate for Payer: Zelis Worker's Compensation |
$31.39
|
|
|
PTA PHYS PERFMNCE TEST
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 97750 GP,CQ
|
| Hospital Charge Code |
4397750
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$34.47 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$43.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$103.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$43.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$34.47
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$64.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$138.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Humana ChoiceCare |
$44.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$35.17
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$103.80
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$40.61
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$35.17
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$152.24
|
| Rate for Payer: United Healthcare Commercial |
$147.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$35.17
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$86.50
|
| Rate for Payer: Zelis Worker's Compensation |
$45.29
|
|
|
PTA PHYS PERFMNCE TEST
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 97750 GP,CQ
|
| Hospital Charge Code |
4397750
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$47.23 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$66.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$121.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Worker's Compensation |
$47.23
|
|
|
PTA PROSTHETIC TNG 15MIN
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
CPT 97761 GP,CQ
|
| Hospital Charge Code |
4397761
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$42.31 |
| Max. Negotiated Rate |
$147.25 |
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$131.75
|
| Rate for Payer: First Health Commercial |
$139.50
|
| Rate for Payer: First Health Workers Compensation |
$59.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$139.50
|
| Rate for Payer: GEHA Commercial |
$108.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$139.50
|
| Rate for Payer: Multiplan All |
$141.05
|
| Rate for Payer: OMNI Networks Commercial |
$108.50
|
| Rate for Payer: One Health Plan PPO/POS |
$139.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$147.25
|
| Rate for Payer: Three Rivers Provider Network All |
$116.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$144.15
|
| Rate for Payer: Zelis Auto |
$62.00
|
| Rate for Payer: Zelis Worker's Compensation |
$42.31
|
|
|
PTA PROSTHETIC TNG 15MIN
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
CPT 97761 GP,CQ
|
| Hospital Charge Code |
4397761
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$40.30 |
| Max. Negotiated Rate |
$147.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$87.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$93.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$87.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$69.09
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$131.75
|
| Rate for Payer: First Health Commercial |
$139.50
|
| Rate for Payer: First Health Workers Compensation |
$77.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$139.50
|
| Rate for Payer: GEHA Commercial |
$124.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$139.50
|
| Rate for Payer: Humana ChoiceCare |
$40.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$70.49
|
| Rate for Payer: Multiplan All |
$141.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$93.00
|
| Rate for Payer: OMNI Networks Commercial |
$108.50
|
| Rate for Payer: One Health Plan PPO/POS |
$139.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$81.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$70.49
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$147.25
|
| Rate for Payer: Three Rivers Provider Network All |
$116.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$136.40
|
| Rate for Payer: United Healthcare Commercial |
$131.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$70.49
|
| Rate for Payer: United Payors & United Providers UP&UP |
$144.15
|
| Rate for Payer: Zelis Auto |
$62.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$77.50
|
| Rate for Payer: Zelis Worker's Compensation |
$55.10
|
|
|
PTA RANGE OF MOTION, HAND
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
CPT 95852 GP,CQ
|
| Hospital Charge Code |
4395852
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$23.34 |
| Max. Negotiated Rate |
$133.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$120.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$84.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$120.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$95.84
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cigna Commercial |
$119.85
|
| Rate for Payer: First Health Commercial |
$126.90
|
| Rate for Payer: First Health Workers Compensation |
$33.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$126.90
|
| Rate for Payer: GEHA Commercial |
$112.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$126.90
|
| Rate for Payer: Humana ChoiceCare |
$36.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$97.79
|
| Rate for Payer: Multiplan All |
$128.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$84.60
|
| Rate for Payer: OMNI Networks Commercial |
$98.70
|
| Rate for Payer: One Health Plan PPO/POS |
$126.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$112.91
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$97.79
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$133.95
|
| Rate for Payer: Three Rivers Provider Network All |
$105.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$124.08
|
| Rate for Payer: United Healthcare Commercial |
$119.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$97.79
|
| Rate for Payer: United Payors & United Providers UP&UP |
$131.13
|
| Rate for Payer: Zelis Auto |
$56.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$70.50
|
| Rate for Payer: Zelis Worker's Compensation |
$23.34
|
|
|
PTA RANGE OF MOTION, HAND
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
CPT 95852 GP,CQ
|
| Hospital Charge Code |
4395852
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$38.49 |
| Max. Negotiated Rate |
$133.95 |
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cigna Commercial |
$119.85
|
| Rate for Payer: First Health Commercial |
$126.90
|
| Rate for Payer: First Health Workers Compensation |
$54.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$126.90
|
| Rate for Payer: GEHA Commercial |
$98.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$126.90
|
| Rate for Payer: Multiplan All |
$128.31
|
| Rate for Payer: OMNI Networks Commercial |
$98.70
|
| Rate for Payer: One Health Plan PPO/POS |
$126.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$133.95
|
| Rate for Payer: Three Rivers Provider Network All |
$105.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$131.13
|
| Rate for Payer: Zelis Auto |
$56.40
|
| Rate for Payer: Zelis Worker's Compensation |
$38.49
|
|
|
PTA RANGE OF MOTION MEASUREMENT AND REPO
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 95851 GP,CQ
|
| Hospital Charge Code |
4398005
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$28.48 |
| Max. Negotiated Rate |
$207.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$120.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$130.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$120.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$95.84
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cigna Commercial |
$185.30
|
| Rate for Payer: First Health Commercial |
$196.20
|
| Rate for Payer: First Health Workers Compensation |
$40.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$196.20
|
| Rate for Payer: GEHA Commercial |
$174.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$196.20
|
| Rate for Payer: Humana ChoiceCare |
$56.68
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$97.79
|
| Rate for Payer: Multiplan All |
$198.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$130.80
|
| Rate for Payer: OMNI Networks Commercial |
$152.60
|
| Rate for Payer: One Health Plan PPO/POS |
$196.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$112.91
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$97.79
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$207.10
|
| Rate for Payer: Three Rivers Provider Network All |
$163.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$191.84
|
| Rate for Payer: United Healthcare Commercial |
$185.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$97.79
|
| Rate for Payer: United Payors & United Providers UP&UP |
$202.74
|
| Rate for Payer: Zelis Auto |
$87.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$109.00
|
| Rate for Payer: Zelis Worker's Compensation |
$28.48
|
|
|
PTA RANGE OF MOTION MEASUREMENT AND REPO
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 95851 GP,CQ
|
| Hospital Charge Code |
4398005
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$59.51 |
| Max. Negotiated Rate |
$207.10 |
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cigna Commercial |
$185.30
|
| Rate for Payer: First Health Commercial |
$196.20
|
| Rate for Payer: First Health Workers Compensation |
$84.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$196.20
|
| Rate for Payer: GEHA Commercial |
$152.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$196.20
|
| Rate for Payer: Multiplan All |
$198.38
|
| Rate for Payer: OMNI Networks Commercial |
$152.60
|
| Rate for Payer: One Health Plan PPO/POS |
$196.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$207.10
|
| Rate for Payer: Three Rivers Provider Network All |
$163.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$202.74
|
| Rate for Payer: Zelis Auto |
$87.20
|
| Rate for Payer: Zelis Worker's Compensation |
$59.51
|
|
|
PTA SENSORY INTEGRATION
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT 97533 GP,CQ
|
| Hospital Charge Code |
4398012
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$42.86 |
| Max. Negotiated Rate |
$149.15 |
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$133.45
|
| Rate for Payer: First Health Commercial |
$141.30
|
| Rate for Payer: First Health Workers Compensation |
$60.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$141.30
|
| Rate for Payer: GEHA Commercial |
$109.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$141.30
|
| Rate for Payer: Multiplan All |
$142.87
|
| Rate for Payer: OMNI Networks Commercial |
$109.90
|
| Rate for Payer: One Health Plan PPO/POS |
$141.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$149.15
|
| Rate for Payer: Three Rivers Provider Network All |
$117.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$146.01
|
| Rate for Payer: Zelis Auto |
$62.80
|
| Rate for Payer: Zelis Worker's Compensation |
$42.86
|
|
|
PTA SENSORY INTEGRATION
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT 97533 GP,CQ
|
| Hospital Charge Code |
4398012
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$30.35 |
| Max. Negotiated Rate |
$149.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$38.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$94.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$38.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$30.35
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$133.45
|
| Rate for Payer: First Health Commercial |
$141.30
|
| Rate for Payer: First Health Workers Compensation |
$114.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$141.30
|
| Rate for Payer: GEHA Commercial |
$125.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$141.30
|
| Rate for Payer: Humana ChoiceCare |
$40.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$30.97
|
| Rate for Payer: Multiplan All |
$142.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$94.20
|
| Rate for Payer: OMNI Networks Commercial |
$109.90
|
| Rate for Payer: One Health Plan PPO/POS |
$141.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$35.76
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$30.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$149.15
|
| Rate for Payer: Three Rivers Provider Network All |
$117.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$138.16
|
| Rate for Payer: United Healthcare Commercial |
$133.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$30.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$146.01
|
| Rate for Payer: Zelis Auto |
$62.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$78.50
|
| Rate for Payer: Zelis Worker's Compensation |
$81.24
|
|
|
PT ASSISTIVE TECHNOLOGY ASSESSMENT
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT 97755
|
| Hospital Charge Code |
4397113
|
|
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
|
|
|
PT ASSISTIVE TECHNOLOGY ASSESSMENT
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT 97755
|
| Hospital Charge Code |
4397113
|
|
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 THER ACTIVITY 15 MIN
|
Facility
|
OP
|
$174.00
|
|
|
Service Code
|
CPT 97530 GP,CQ
|
| Hospital Charge Code |
4397530
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$33.62 |
| Max. Negotiated Rate |
$165.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$42.44
|
| 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 |
$42.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$33.62
|
| 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 |
$68.68
|
| 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 |
$34.30
|
| 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 |
$39.61
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$34.30
|
| 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 |
$34.30
|
| 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 |
$48.56
|
|
|
PTA THER ACTIVITY 15 MIN
|
Facility
|
IP
|
$174.00
|
|
|
Service Code
|
CPT 97530 GP,CQ
|
| Hospital Charge Code |
4397530
|
|
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 THER EXER E15
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
CPT 97110 GP,CQ
|
| Hospital Charge Code |
4397110
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$54.87 |
| Max. Negotiated Rate |
$190.95 |
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna Commercial |
$170.85
|
| Rate for Payer: First Health Commercial |
$180.90
|
| Rate for Payer: First Health Workers Compensation |
$77.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$180.90
|
| Rate for Payer: GEHA Commercial |
$140.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$180.90
|
| Rate for Payer: Multiplan All |
$182.91
|
| Rate for Payer: OMNI Networks Commercial |
$140.70
|
| Rate for Payer: One Health Plan PPO/POS |
$180.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$190.95
|
| Rate for Payer: Three Rivers Provider Network All |
$150.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$186.93
|
| Rate for Payer: Zelis Auto |
$80.40
|
| Rate for Payer: Zelis Worker's Compensation |
$54.87
|
|
|
PTA THER EXER E15
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
CPT 97110 GP,CQ
|
| Hospital Charge Code |
4397110
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$39.22 |
| Max. Negotiated Rate |
$190.95 |
| 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 |
$120.60
|
| 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 |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna Commercial |
$170.85
|
| Rate for Payer: First Health Commercial |
$180.90
|
| Rate for Payer: First Health Workers Compensation |
$55.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$180.90
|
| Rate for Payer: GEHA Commercial |
$160.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$180.90
|
| Rate for Payer: Humana ChoiceCare |
$52.26
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$50.21
|
| Rate for Payer: Multiplan All |
$182.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$120.60
|
| Rate for Payer: OMNI Networks Commercial |
$140.70
|
| Rate for Payer: One Health Plan PPO/POS |
$180.90
|
| 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 |
$190.95
|
| Rate for Payer: Three Rivers Provider Network All |
$150.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$176.88
|
| Rate for Payer: United Healthcare Commercial |
$170.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$50.21
|
| Rate for Payer: United Payors & United Providers UP&UP |
$186.93
|
| Rate for Payer: Zelis Auto |
$80.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.50
|
| Rate for Payer: Zelis Worker's Compensation |
$39.22
|
|
|
PTA THER IVNT COG FUN CNTCT EA ADL 15 MI
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 97130 GP,CQ
|
| Hospital Charge Code |
4397130
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.11 |
| Max. Negotiated Rate |
$66.50 |
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$59.50
|
| Rate for Payer: First Health Commercial |
$63.00
|
| Rate for Payer: First Health Workers Compensation |
$27.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$63.00
|
| Rate for Payer: GEHA Commercial |
$49.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$63.00
|
| Rate for Payer: Multiplan All |
$63.70
|
| Rate for Payer: OMNI Networks Commercial |
$49.00
|
| Rate for Payer: One Health Plan PPO/POS |
$63.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$66.50
|
| Rate for Payer: Three Rivers Provider Network All |
$52.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$65.10
|
| Rate for Payer: Zelis Auto |
$28.00
|
| Rate for Payer: Zelis Worker's Compensation |
$19.11
|
|
|
PTA THER IVNT COG FUN CNTCT EA ADL 15 MI
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 97130 GP,CQ
|
| Hospital Charge Code |
4397130
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$66.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$46.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$42.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$46.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$36.65
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$59.50
|
| Rate for Payer: First Health Commercial |
$63.00
|
| Rate for Payer: First Health Workers Compensation |
$41.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$63.00
|
| Rate for Payer: GEHA Commercial |
$56.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$63.00
|
| Rate for Payer: Humana ChoiceCare |
$18.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$37.39
|
| Rate for Payer: Multiplan All |
$63.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$42.00
|
| Rate for Payer: OMNI Networks Commercial |
$49.00
|
| Rate for Payer: One Health Plan PPO/POS |
$63.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$43.18
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$37.39
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$66.50
|
| Rate for Payer: Three Rivers Provider Network All |
$52.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$61.60
|
| Rate for Payer: United Healthcare Commercial |
$59.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$37.39
|
| Rate for Payer: United Payors & United Providers UP&UP |
$65.10
|
| Rate for Payer: Zelis Auto |
$28.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$35.00
|
| Rate for Payer: Zelis Worker's Compensation |
$29.41
|
|
