|
PTA THER IVNTJ COG FUNC CNTCT 1ST 15 MIN
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
CPT 97129 GP,CQ
|
| Hospital Charge Code |
4397129
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.66 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna Commercial |
$61.20
|
| Rate for Payer: First Health Commercial |
$64.80
|
| Rate for Payer: First Health Workers Compensation |
$27.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$64.80
|
| Rate for Payer: GEHA Commercial |
$50.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$64.80
|
| Rate for Payer: Multiplan All |
$65.52
|
| Rate for Payer: OMNI Networks Commercial |
$50.40
|
| Rate for Payer: One Health Plan PPO/POS |
$64.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$68.40
|
| Rate for Payer: Three Rivers Provider Network All |
$54.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$66.96
|
| Rate for Payer: Zelis Auto |
$28.80
|
| Rate for Payer: Zelis Worker's Compensation |
$19.66
|
|
|
PTA THER IVNTJ COG FUNC CNTCT 1ST 15 MIN
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT 97129 GP,CQ
|
| Hospital Charge Code |
4397129
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.72 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$48.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$43.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$48.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$38.35
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna Commercial |
$61.20
|
| Rate for Payer: First Health Commercial |
$64.80
|
| Rate for Payer: First Health Workers Compensation |
$43.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$64.80
|
| Rate for Payer: GEHA Commercial |
$57.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$64.80
|
| Rate for Payer: Humana ChoiceCare |
$18.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$39.13
|
| Rate for Payer: Multiplan All |
$65.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$43.20
|
| Rate for Payer: OMNI Networks Commercial |
$50.40
|
| Rate for Payer: One Health Plan PPO/POS |
$64.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$45.18
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$39.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$68.40
|
| Rate for Payer: Three Rivers Provider Network All |
$54.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$63.36
|
| Rate for Payer: United Healthcare Commercial |
$61.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$39.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$66.96
|
| Rate for Payer: Zelis Auto |
$28.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$36.00
|
| Rate for Payer: Zelis Worker's Compensation |
$30.81
|
|
|
PTA ULTRAVIOLET THERAPY
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
CPT 97028 GP,CQ
|
| Hospital Charge Code |
4398009
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$11.21 |
| Max. Negotiated Rate |
$116.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$17.46
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$73.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$17.46
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$13.83
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cigna Commercial |
$104.55
|
| Rate for Payer: First Health Commercial |
$110.70
|
| Rate for Payer: First Health Workers Compensation |
$15.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$110.70
|
| Rate for Payer: GEHA Commercial |
$98.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$110.70
|
| Rate for Payer: Humana ChoiceCare |
$31.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$14.11
|
| Rate for Payer: Multiplan All |
$111.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$73.80
|
| Rate for Payer: OMNI Networks Commercial |
$86.10
|
| Rate for Payer: One Health Plan PPO/POS |
$110.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$16.30
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$14.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$116.85
|
| Rate for Payer: Three Rivers Provider Network All |
$92.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$108.24
|
| Rate for Payer: United Healthcare Commercial |
$104.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$114.39
|
| Rate for Payer: Zelis Auto |
$49.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$61.50
|
| Rate for Payer: Zelis Worker's Compensation |
$11.21
|
|
|
PTA ULTRAVIOLET THERAPY
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
CPT 97028 GP,CQ
|
| Hospital Charge Code |
4398009
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$33.58 |
| Max. Negotiated Rate |
$116.85 |
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cigna Commercial |
$104.55
|
| Rate for Payer: First Health Commercial |
$110.70
|
| Rate for Payer: First Health Workers Compensation |
$47.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$110.70
|
| Rate for Payer: GEHA Commercial |
$86.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$110.70
|
| Rate for Payer: Multiplan All |
$111.93
|
| Rate for Payer: OMNI Networks Commercial |
$86.10
|
| Rate for Payer: One Health Plan PPO/POS |
$110.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$116.85
|
| Rate for Payer: Three Rivers Provider Network All |
$92.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$114.39
|
| Rate for Payer: Zelis Auto |
$49.20
|
| Rate for Payer: Zelis Worker's Compensation |
$33.58
|
|
|
PTA UNLISTED PHYSICAL MEDICINE/REHABILIT
|
Facility
|
OP
|
$318.00
|
|
|
Service Code
|
CPT 97799 GP,CQ
|
| Hospital Charge Code |
4398015
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$79.50 |
| Max. Negotiated Rate |
$302.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$190.80
|
| Rate for Payer: Cash Price |
$190.80
|
| Rate for Payer: Cigna Commercial |
$270.30
|
| Rate for Payer: First Health Commercial |
$286.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$286.20
|
| Rate for Payer: GEHA Commercial |
$254.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$286.20
|
| Rate for Payer: Humana ChoiceCare |
$82.68
|
| Rate for Payer: Multiplan All |
$289.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$190.80
|
| Rate for Payer: OMNI Networks Commercial |
$222.60
|
| Rate for Payer: One Health Plan PPO/POS |
$286.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$302.10
|
| Rate for Payer: Three Rivers Provider Network All |
$238.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$279.84
|
| Rate for Payer: United Healthcare Commercial |
$270.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$79.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$295.74
|
| Rate for Payer: Zelis Auto |
$127.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$159.00
|
|
|
PTA UNLISTED PHYSICAL MEDICINE/REHABILIT
|
Facility
|
IP
|
$318.00
|
|
|
Service Code
|
CPT 97799 GP,CQ
|
| Hospital Charge Code |
4398015
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$86.81 |
| Max. Negotiated Rate |
$302.10 |
| Rate for Payer: Cash Price |
$190.80
|
| Rate for Payer: Cigna Commercial |
$270.30
|
| Rate for Payer: First Health Commercial |
$286.20
|
| Rate for Payer: First Health Workers Compensation |
$122.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$286.20
|
| Rate for Payer: GEHA Commercial |
$222.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$286.20
|
| Rate for Payer: Multiplan All |
$289.38
|
| Rate for Payer: OMNI Networks Commercial |
$222.60
|
| Rate for Payer: One Health Plan PPO/POS |
$286.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$302.10
|
| Rate for Payer: Three Rivers Provider Network All |
$238.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$295.74
|
| Rate for Payer: Zelis Auto |
$127.20
|
| Rate for Payer: Zelis Worker's Compensation |
$86.81
|
|
|
PTA UNLISTED THERAPEUTIC PROCEDURE (SPEC
|
Facility
|
OP
|
$143.00
|
|
|
Service Code
|
CPT 97139 GP,CQ
|
| Hospital Charge Code |
4398011
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.16 |
| Max. Negotiated Rate |
$135.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$26.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$85.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$26.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$21.16
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna Commercial |
$121.55
|
| Rate for Payer: First Health Commercial |
$128.70
|
| Rate for Payer: First Health Workers Compensation |
$55.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$128.70
|
| Rate for Payer: GEHA Commercial |
$114.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$128.70
|
| Rate for Payer: Humana ChoiceCare |
$37.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$21.59
|
| Rate for Payer: Multiplan All |
$130.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$85.80
|
| Rate for Payer: OMNI Networks Commercial |
$100.10
|
| Rate for Payer: One Health Plan PPO/POS |
$128.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$24.93
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$21.59
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$135.85
|
| Rate for Payer: Three Rivers Provider Network All |
$107.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$125.84
|
| Rate for Payer: United Healthcare Commercial |
$121.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$21.59
|
| Rate for Payer: United Payors & United Providers UP&UP |
$132.99
|
| Rate for Payer: Zelis Auto |
$57.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$71.50
|
| Rate for Payer: Zelis Worker's Compensation |
$39.04
|
|
|
PTA UNLISTED THERAPEUTIC PROCEDURE (SPEC
|
Facility
|
IP
|
$143.00
|
|
|
Service Code
|
CPT 97139 GP,CQ
|
| Hospital Charge Code |
4398011
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$39.04 |
| Max. Negotiated Rate |
$135.85 |
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna Commercial |
$121.55
|
| Rate for Payer: First Health Commercial |
$128.70
|
| Rate for Payer: First Health Workers Compensation |
$55.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$128.70
|
| Rate for Payer: GEHA Commercial |
$100.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$128.70
|
| Rate for Payer: Multiplan All |
$130.13
|
| Rate for Payer: OMNI Networks Commercial |
$100.10
|
| Rate for Payer: One Health Plan PPO/POS |
$128.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$135.85
|
| Rate for Payer: Three Rivers Provider Network All |
$107.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$132.99
|
| Rate for Payer: Zelis Auto |
$57.20
|
| Rate for Payer: Zelis Worker's Compensation |
$39.04
|
|
|
PTA US-15 MIN
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
CPT 97035 GP,CQ
|
| Hospital Charge Code |
4397035
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$34.94 |
| Max. Negotiated Rate |
$121.60 |
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cigna Commercial |
$108.80
|
| Rate for Payer: First Health Commercial |
$115.20
|
| Rate for Payer: First Health Workers Compensation |
$49.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$115.20
|
| Rate for Payer: GEHA Commercial |
$89.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$115.20
|
| Rate for Payer: Multiplan All |
$116.48
|
| Rate for Payer: OMNI Networks Commercial |
$89.60
|
| Rate for Payer: One Health Plan PPO/POS |
$115.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$121.60
|
| Rate for Payer: Three Rivers Provider Network All |
$96.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$119.04
|
| Rate for Payer: Zelis Auto |
$51.20
|
| Rate for Payer: Zelis Worker's Compensation |
$34.94
|
|
|
PTA US-15 MIN
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
CPT 97035 GP,CQ
|
| Hospital Charge Code |
4397035
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.68 |
| Max. Negotiated Rate |
$121.60 |
| 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 |
$76.80
|
| 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 |
$76.80
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cigna Commercial |
$108.80
|
| Rate for Payer: First Health Commercial |
$115.20
|
| Rate for Payer: First Health Workers Compensation |
$26.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$115.20
|
| Rate for Payer: GEHA Commercial |
$102.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$115.20
|
| Rate for Payer: Humana ChoiceCare |
$33.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24.02
|
| Rate for Payer: Multiplan All |
$116.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$76.80
|
| Rate for Payer: OMNI Networks Commercial |
$89.60
|
| Rate for Payer: One Health Plan PPO/POS |
$115.20
|
| 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 |
$121.60
|
| Rate for Payer: Three Rivers Provider Network All |
$96.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$112.64
|
| Rate for Payer: United Healthcare Commercial |
$108.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.02
|
| Rate for Payer: United Payors & United Providers UP&UP |
$119.04
|
| Rate for Payer: Zelis Auto |
$51.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$64.00
|
| Rate for Payer: Zelis Worker's Compensation |
$18.68
|
|
|
PTA WHEELCHAIR MNGMT TRA
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 97542 GP,CQ
|
| Hospital Charge Code |
4397542
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$32.45 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$40.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$40.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$32.45
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cigna Commercial |
$129.20
|
| Rate for Payer: First Health Commercial |
$136.80
|
| Rate for Payer: First Health Workers Compensation |
$60.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$136.80
|
| Rate for Payer: GEHA Commercial |
$121.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$136.80
|
| Rate for Payer: Humana ChoiceCare |
$39.52
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$33.11
|
| Rate for Payer: Multiplan All |
$138.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$91.20
|
| Rate for Payer: OMNI Networks Commercial |
$106.40
|
| Rate for Payer: One Health Plan PPO/POS |
$136.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$38.23
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$33.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$144.40
|
| Rate for Payer: Three Rivers Provider Network All |
$114.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$133.76
|
| Rate for Payer: United Healthcare Commercial |
$129.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$33.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$141.36
|
| Rate for Payer: Zelis Auto |
$60.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$76.00
|
| Rate for Payer: Zelis Worker's Compensation |
$42.49
|
|
|
PTA WHEELCHAIR MNGMT TRA
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 97542 GP,CQ
|
| Hospital Charge Code |
4397542
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$41.50 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cigna Commercial |
$129.20
|
| Rate for Payer: First Health Commercial |
$136.80
|
| Rate for Payer: First Health Workers Compensation |
$58.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$136.80
|
| Rate for Payer: GEHA Commercial |
$106.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$136.80
|
| Rate for Payer: Multiplan All |
$138.32
|
| Rate for Payer: OMNI Networks Commercial |
$106.40
|
| Rate for Payer: One Health Plan PPO/POS |
$136.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$144.40
|
| Rate for Payer: Three Rivers Provider Network All |
$114.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$141.36
|
| Rate for Payer: Zelis Auto |
$60.80
|
| Rate for Payer: Zelis Worker's Compensation |
$41.50
|
|
|
PTA WORK HARDENING INITIAL 2 HOURS
|
Facility
|
OP
|
$761.00
|
|
|
Service Code
|
CPT 97545 GP,CQ
|
| Hospital Charge Code |
4398013
|
|
Hospital Revenue Code
|
422
|
| Min. Negotiated Rate |
$112.53 |
| Max. Negotiated Rate |
$722.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$456.60
|
| Rate for Payer: Cash Price |
$456.60
|
| Rate for Payer: Cash Price |
$456.60
|
| Rate for Payer: Cigna Commercial |
$646.85
|
| Rate for Payer: First Health Commercial |
$684.90
|
| Rate for Payer: First Health Workers Compensation |
$159.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$684.90
|
| Rate for Payer: GEHA Commercial |
$608.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$684.90
|
| Rate for Payer: Humana ChoiceCare |
$197.86
|
| Rate for Payer: Multiplan All |
$692.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$456.60
|
| Rate for Payer: OMNI Networks Commercial |
$532.70
|
| Rate for Payer: One Health Plan PPO/POS |
$684.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$722.95
|
| Rate for Payer: Three Rivers Provider Network All |
$570.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$669.68
|
| Rate for Payer: United Healthcare Commercial |
$646.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$190.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$707.73
|
| Rate for Payer: Zelis Auto |
$304.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$380.50
|
| Rate for Payer: Zelis Worker's Compensation |
$112.53
|
|
|
PTA WORK HARDENING INITIAL 2 HOURS
|
Facility
|
IP
|
$761.00
|
|
|
Service Code
|
CPT 97545 GP,CQ
|
| Hospital Charge Code |
4398013
|
|
Hospital Revenue Code
|
422
|
| Min. Negotiated Rate |
$207.75 |
| Max. Negotiated Rate |
$722.95 |
| Rate for Payer: Cash Price |
$456.60
|
| Rate for Payer: Cigna Commercial |
$646.85
|
| Rate for Payer: First Health Commercial |
$684.90
|
| Rate for Payer: First Health Workers Compensation |
$293.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$684.90
|
| Rate for Payer: GEHA Commercial |
$532.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$684.90
|
| Rate for Payer: Multiplan All |
$692.51
|
| Rate for Payer: OMNI Networks Commercial |
$532.70
|
| Rate for Payer: One Health Plan PPO/POS |
$684.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$722.95
|
| Rate for Payer: Three Rivers Provider Network All |
$570.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$707.73
|
| Rate for Payer: Zelis Auto |
$304.40
|
| Rate for Payer: Zelis Worker's Compensation |
$207.75
|
|
|
PT BIOFEEDBACK TRAIN, ANY ME
|
Facility
|
OP
|
$256.00
|
|
|
Service Code
|
CPT 90901
|
| Hospital Charge Code |
4303008
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$54.16 |
| Max. Negotiated Rate |
$243.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$153.60
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cigna Commercial |
$217.60
|
| Rate for Payer: First Health Commercial |
$230.40
|
| Rate for Payer: First Health Workers Compensation |
$76.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$230.40
|
| Rate for Payer: GEHA Commercial |
$204.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$230.40
|
| Rate for Payer: Humana ChoiceCare |
$66.56
|
| Rate for Payer: Multiplan All |
$232.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$153.60
|
| Rate for Payer: OMNI Networks Commercial |
$179.20
|
| Rate for Payer: One Health Plan PPO/POS |
$230.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$243.20
|
| Rate for Payer: Three Rivers Provider Network All |
$192.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$225.28
|
| Rate for Payer: United Healthcare Commercial |
$217.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$64.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$238.08
|
| Rate for Payer: Zelis Auto |
$102.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$128.00
|
| Rate for Payer: Zelis Worker's Compensation |
$54.16
|
|
|
PT BIOFEEDBACK TRAIN, ANY ME
|
Facility
|
IP
|
$256.00
|
|
|
Service Code
|
CPT 90901
|
| Hospital Charge Code |
4303008
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$69.89 |
| Max. Negotiated Rate |
$243.20 |
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cigna Commercial |
$217.60
|
| Rate for Payer: First Health Commercial |
$230.40
|
| Rate for Payer: First Health Workers Compensation |
$98.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$230.40
|
| Rate for Payer: GEHA Commercial |
$179.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$230.40
|
| Rate for Payer: Multiplan All |
$232.96
|
| Rate for Payer: OMNI Networks Commercial |
$179.20
|
| Rate for Payer: One Health Plan PPO/POS |
$230.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$243.20
|
| Rate for Payer: Three Rivers Provider Network All |
$192.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$238.08
|
| Rate for Payer: Zelis Auto |
$102.40
|
| Rate for Payer: Zelis Worker's Compensation |
$69.89
|
|
|
PT COMM WORK REINT
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT 97537
|
| Hospital Charge Code |
4310011
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$31.63 |
| Max. Negotiated Rate |
$149.15 |
| 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 |
$94.20
|
| 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 |
$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 |
$60.09
|
| 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 |
$32.28
|
| 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 |
$37.27
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$32.28
|
| 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 |
$32.28
|
| 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 |
$42.49
|
|
|
PT COMM WORK REINT
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT 97537
|
| Hospital Charge Code |
4310011
|
|
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
|
|
|
PT CONTRAST BATH
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
4307091
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.68 |
| Max. Negotiated Rate |
$119.70 |
| 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 |
$75.60
|
| 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 |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna Commercial |
$107.10
|
| Rate for Payer: First Health Commercial |
$113.40
|
| Rate for Payer: First Health Workers Compensation |
$26.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$113.40
|
| Rate for Payer: GEHA Commercial |
$100.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$113.40
|
| Rate for Payer: Humana ChoiceCare |
$32.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24.02
|
| Rate for Payer: Multiplan All |
$114.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$75.60
|
| Rate for Payer: OMNI Networks Commercial |
$88.20
|
| Rate for Payer: One Health Plan PPO/POS |
$113.40
|
| 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 |
$119.70
|
| Rate for Payer: Three Rivers Provider Network All |
$94.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$110.88
|
| Rate for Payer: United Healthcare Commercial |
$107.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.02
|
| Rate for Payer: United Payors & United Providers UP&UP |
$117.18
|
| Rate for Payer: Zelis Auto |
$50.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$63.00
|
| Rate for Payer: Zelis Worker's Compensation |
$18.68
|
|
|
PT CONTRAST BATH
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
4307091
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$34.40 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna Commercial |
$107.10
|
| Rate for Payer: First Health Commercial |
$113.40
|
| Rate for Payer: First Health Workers Compensation |
$48.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$113.40
|
| Rate for Payer: GEHA Commercial |
$88.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$113.40
|
| Rate for Payer: Multiplan All |
$114.66
|
| Rate for Payer: OMNI Networks Commercial |
$88.20
|
| Rate for Payer: One Health Plan PPO/POS |
$113.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$119.70
|
| Rate for Payer: Three Rivers Provider Network All |
$94.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$117.18
|
| Rate for Payer: Zelis Auto |
$50.40
|
| Rate for Payer: Zelis Worker's Compensation |
$34.40
|
|
|
PT CPM SET UP
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT 97039
|
| Hospital Charge Code |
4303215
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.52 |
| Max. Negotiated Rate |
$128.25 |
| 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 |
$81.00
|
| 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 |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$114.75
|
| Rate for Payer: First Health Commercial |
$121.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$121.50
|
| Rate for Payer: GEHA Commercial |
$108.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$121.50
|
| Rate for Payer: Humana ChoiceCare |
$35.10
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$17.87
|
| Rate for Payer: Multiplan All |
$122.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$81.00
|
| Rate for Payer: OMNI Networks Commercial |
$94.50
|
| Rate for Payer: One Health Plan PPO/POS |
$121.50
|
| 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 |
$128.25
|
| Rate for Payer: Three Rivers Provider Network All |
$101.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$118.80
|
| Rate for Payer: United Healthcare Commercial |
$114.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17.87
|
| Rate for Payer: United Payors & United Providers UP&UP |
$125.55
|
| Rate for Payer: Zelis Auto |
$54.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$67.50
|
|
|
PT CPM SET UP
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT 97039
|
| Hospital Charge Code |
4303215
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$36.85 |
| Max. Negotiated Rate |
$128.25 |
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$114.75
|
| Rate for Payer: First Health Commercial |
$121.50
|
| Rate for Payer: First Health Workers Compensation |
$52.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$121.50
|
| Rate for Payer: GEHA Commercial |
$94.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$121.50
|
| Rate for Payer: Multiplan All |
$122.85
|
| Rate for Payer: OMNI Networks Commercial |
$94.50
|
| Rate for Payer: One Health Plan PPO/POS |
$121.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$128.25
|
| Rate for Payer: Three Rivers Provider Network All |
$101.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$125.55
|
| Rate for Payer: Zelis Auto |
$54.00
|
| Rate for Payer: Zelis Worker's Compensation |
$36.85
|
|
|
PT DEBRIDEMENT 20 CM
|
Facility
|
IP
|
$688.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
4310013
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$187.82 |
| Max. Negotiated Rate |
$653.60 |
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cigna Commercial |
$584.80
|
| Rate for Payer: First Health Commercial |
$619.20
|
| Rate for Payer: First Health Workers Compensation |
$265.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$619.20
|
| Rate for Payer: GEHA Commercial |
$481.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$619.20
|
| Rate for Payer: Multiplan All |
$626.08
|
| Rate for Payer: OMNI Networks Commercial |
$481.60
|
| Rate for Payer: One Health Plan PPO/POS |
$619.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$653.60
|
| Rate for Payer: Three Rivers Provider Network All |
$516.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$639.84
|
| Rate for Payer: Zelis Auto |
$275.20
|
| Rate for Payer: Zelis Worker's Compensation |
$187.82
|
|
|
PT DEBRIDEMENT 20 CM
|
Facility
|
OP
|
$688.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
4310013
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$123.45 |
| Max. Negotiated Rate |
$653.60 |
| 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 |
$412.80
|
| 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: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cigna Commercial |
$584.80
|
| Rate for Payer: First Health Commercial |
$619.20
|
| Rate for Payer: First Health Workers Compensation |
$187.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$619.20
|
| Rate for Payer: GEHA Commercial |
$550.40
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$619.20
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$125.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$626.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$481.60
|
| Rate for Payer: One Health Plan PPO/POS |
$619.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$145.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$125.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$653.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$516.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Commercial |
$584.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$125.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$639.84
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$275.20
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$132.60
|
|
|
PT DEBRIDEMENT ADDL 20 CM
|
Facility
|
OP
|
$587.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
4310014
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$60.23 |
| Max. Negotiated Rate |
$557.65 |
| 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 |
$352.20
|
| 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 |
$352.20
|
| Rate for Payer: Cash Price |
$352.20
|
| Rate for Payer: Cigna Commercial |
$498.95
|
| Rate for Payer: First Health Commercial |
$528.30
|
| Rate for Payer: First Health Workers Compensation |
$85.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$528.30
|
| Rate for Payer: GEHA Commercial |
$469.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$528.30
|
| Rate for Payer: Humana ChoiceCare |
$152.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$125.97
|
| Rate for Payer: Multiplan All |
$534.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$352.20
|
| Rate for Payer: OMNI Networks Commercial |
$410.90
|
| Rate for Payer: One Health Plan PPO/POS |
$528.30
|
| 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 |
$557.65
|
| Rate for Payer: Three Rivers Provider Network All |
$440.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$516.56
|
| Rate for Payer: United Healthcare Commercial |
$498.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$125.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$545.91
|
| Rate for Payer: Zelis Auto |
$234.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$293.50
|
| Rate for Payer: Zelis Worker's Compensation |
$60.23
|
|
