|
PT DEBRIDEMENT ADDL 20 CM
|
Facility
|
IP
|
$587.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
4310014
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$160.25 |
| Max. Negotiated Rate |
$557.65 |
| 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 |
$226.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$528.30
|
| Rate for Payer: GEHA Commercial |
$410.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$528.30
|
| Rate for Payer: Multiplan All |
$534.17
|
| Rate for Payer: OMNI Networks Commercial |
$410.90
|
| Rate for Payer: One Health Plan PPO/POS |
$528.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$557.65
|
| Rate for Payer: Three Rivers Provider Network All |
$440.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$545.91
|
| Rate for Payer: Zelis Auto |
$234.80
|
| Rate for Payer: Zelis Worker's Compensation |
$160.25
|
|
|
PT DEVELOPMENTAL SCREENING
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
4395834
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$14.32 |
| Max. Negotiated Rate |
$104.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$18.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$66.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$18.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$14.32
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$93.50
|
| Rate for Payer: First Health Commercial |
$99.00
|
| Rate for Payer: First Health Workers Compensation |
$21.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$99.00
|
| Rate for Payer: GEHA Commercial |
$88.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$99.00
|
| Rate for Payer: Humana ChoiceCare |
$28.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$14.61
|
| Rate for Payer: Multiplan All |
$100.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$66.00
|
| Rate for Payer: OMNI Networks Commercial |
$77.00
|
| Rate for Payer: One Health Plan PPO/POS |
$99.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$16.87
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$14.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$104.50
|
| Rate for Payer: Three Rivers Provider Network All |
$82.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$96.80
|
| Rate for Payer: United Healthcare Commercial |
$93.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$102.30
|
| Rate for Payer: Zelis Auto |
$44.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$55.00
|
| Rate for Payer: Zelis Worker's Compensation |
$15.54
|
|
|
PT DEVELOPMENTAL SCREENING
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
4395834
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$30.03 |
| Max. Negotiated Rate |
$104.50 |
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$93.50
|
| Rate for Payer: First Health Commercial |
$99.00
|
| Rate for Payer: First Health Workers Compensation |
$42.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$99.00
|
| Rate for Payer: GEHA Commercial |
$77.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$99.00
|
| Rate for Payer: Multiplan All |
$100.10
|
| Rate for Payer: OMNI Networks Commercial |
$77.00
|
| Rate for Payer: One Health Plan PPO/POS |
$99.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$104.50
|
| Rate for Payer: Three Rivers Provider Network All |
$82.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$102.30
|
| Rate for Payer: Zelis Auto |
$44.00
|
| Rate for Payer: Zelis Worker's Compensation |
$30.03
|
|
|
PT ELEC STIM CONST ATTE
|
Facility
|
IP
|
$167.00
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
4303030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$45.59 |
| Max. Negotiated Rate |
$158.65 |
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cigna Commercial |
$141.95
|
| Rate for Payer: First Health Commercial |
$150.30
|
| Rate for Payer: First Health Workers Compensation |
$64.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$150.30
|
| Rate for Payer: GEHA Commercial |
$116.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$150.30
|
| Rate for Payer: Multiplan All |
$151.97
|
| Rate for Payer: OMNI Networks Commercial |
$116.90
|
| Rate for Payer: One Health Plan PPO/POS |
$150.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$158.65
|
| Rate for Payer: Three Rivers Provider Network All |
$125.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$155.31
|
| Rate for Payer: Zelis Auto |
$66.80
|
| Rate for Payer: Zelis Worker's Compensation |
$45.59
|
|
|
PT ELEC STIM CONST ATTE
|
Facility
|
OP
|
$167.00
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
4303030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.61 |
| Max. Negotiated Rate |
$158.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$30.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$100.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$30.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$24.29
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cigna Commercial |
$141.95
|
| Rate for Payer: First Health Commercial |
$150.30
|
| Rate for Payer: First Health Workers Compensation |
$27.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$150.30
|
| Rate for Payer: GEHA Commercial |
$133.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$150.30
|
| Rate for Payer: Humana ChoiceCare |
$43.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24.78
|
| Rate for Payer: Multiplan All |
$151.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$100.20
|
| Rate for Payer: OMNI Networks Commercial |
$116.90
|
| Rate for Payer: One Health Plan PPO/POS |
$150.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$28.62
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$24.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$158.65
|
| Rate for Payer: Three Rivers Provider Network All |
$125.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$146.96
|
| Rate for Payer: United Healthcare Commercial |
$141.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$155.31
|
| Rate for Payer: Zelis Auto |
$66.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$83.50
|
| Rate for Payer: Zelis Worker's Compensation |
$19.61
|
|
|
PT EVAL HIGH COMPLEX
|
Facility
|
IP
|
$554.00
|
|
|
Service Code
|
CPT 97163
|
| Hospital Charge Code |
4310022
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$151.24 |
| Max. Negotiated Rate |
$526.30 |
| Rate for Payer: Cash Price |
$332.40
|
| Rate for Payer: Cigna Commercial |
$470.90
|
| Rate for Payer: First Health Commercial |
$498.60
|
| Rate for Payer: First Health Workers Compensation |
$213.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$498.60
|
| Rate for Payer: GEHA Commercial |
$387.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$498.60
|
| Rate for Payer: Multiplan All |
$504.14
|
| Rate for Payer: OMNI Networks Commercial |
$387.80
|
| Rate for Payer: One Health Plan PPO/POS |
$498.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$526.30
|
| Rate for Payer: Three Rivers Provider Network All |
$415.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$515.22
|
| Rate for Payer: Zelis Auto |
$221.60
|
| Rate for Payer: Zelis Worker's Compensation |
$151.24
|
|
|
PT EVAL HIGH COMPLEX
|
Facility
|
OP
|
$554.00
|
|
|
Service Code
|
CPT 97163
|
| Hospital Charge Code |
4310022
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$134.93 |
| Max. Negotiated Rate |
$526.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$212.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$332.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$212.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$168.41
|
| Rate for Payer: Cash Price |
$332.40
|
| Rate for Payer: Cash Price |
$332.40
|
| Rate for Payer: Cigna Commercial |
$470.90
|
| Rate for Payer: First Health Commercial |
$498.60
|
| Rate for Payer: First Health Workers Compensation |
$190.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$498.60
|
| Rate for Payer: GEHA Commercial |
$443.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$498.60
|
| Rate for Payer: Humana ChoiceCare |
$144.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$171.84
|
| Rate for Payer: Multiplan All |
$504.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$332.40
|
| Rate for Payer: OMNI Networks Commercial |
$387.80
|
| Rate for Payer: One Health Plan PPO/POS |
$498.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$198.41
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$171.84
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$526.30
|
| Rate for Payer: Three Rivers Provider Network All |
$415.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$487.52
|
| Rate for Payer: United Healthcare Commercial |
$470.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$171.84
|
| Rate for Payer: United Payors & United Providers UP&UP |
$515.22
|
| Rate for Payer: Zelis Auto |
$221.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$277.00
|
| Rate for Payer: Zelis Worker's Compensation |
$134.93
|
|
|
PT EVAL LOW COMPLEX
|
Facility
|
OP
|
$416.00
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
4310020
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$108.16 |
| Max. Negotiated Rate |
$395.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$212.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$249.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$212.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$168.41
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cigna Commercial |
$353.60
|
| Rate for Payer: First Health Commercial |
$374.40
|
| Rate for Payer: First Health Workers Compensation |
$190.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$374.40
|
| Rate for Payer: GEHA Commercial |
$332.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$374.40
|
| Rate for Payer: Humana ChoiceCare |
$108.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$171.84
|
| Rate for Payer: Multiplan All |
$378.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$249.60
|
| Rate for Payer: OMNI Networks Commercial |
$291.20
|
| Rate for Payer: One Health Plan PPO/POS |
$374.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$198.41
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$171.84
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$395.20
|
| Rate for Payer: Three Rivers Provider Network All |
$312.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$366.08
|
| Rate for Payer: United Healthcare Commercial |
$353.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$171.84
|
| Rate for Payer: United Payors & United Providers UP&UP |
$386.88
|
| Rate for Payer: Zelis Auto |
$166.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$208.00
|
| Rate for Payer: Zelis Worker's Compensation |
$134.93
|
|
|
PT EVAL LOW COMPLEX
|
Facility
|
IP
|
$416.00
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
4310020
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$113.57 |
| Max. Negotiated Rate |
$395.20 |
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cigna Commercial |
$353.60
|
| Rate for Payer: First Health Commercial |
$374.40
|
| Rate for Payer: First Health Workers Compensation |
$160.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$374.40
|
| Rate for Payer: GEHA Commercial |
$291.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$374.40
|
| Rate for Payer: Multiplan All |
$378.56
|
| Rate for Payer: OMNI Networks Commercial |
$291.20
|
| Rate for Payer: One Health Plan PPO/POS |
$374.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$395.20
|
| Rate for Payer: Three Rivers Provider Network All |
$312.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$386.88
|
| Rate for Payer: Zelis Auto |
$166.40
|
| Rate for Payer: Zelis Worker's Compensation |
$113.57
|
|
|
PT EVAL MOD COMPLEX
|
Facility
|
OP
|
$488.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
4310021
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$126.88 |
| Max. Negotiated Rate |
$463.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$212.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$292.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$212.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$168.41
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cigna Commercial |
$414.80
|
| Rate for Payer: First Health Commercial |
$439.20
|
| Rate for Payer: First Health Workers Compensation |
$190.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$439.20
|
| Rate for Payer: GEHA Commercial |
$390.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$439.20
|
| Rate for Payer: Humana ChoiceCare |
$126.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$171.84
|
| Rate for Payer: Multiplan All |
$444.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$292.80
|
| Rate for Payer: OMNI Networks Commercial |
$341.60
|
| Rate for Payer: One Health Plan PPO/POS |
$439.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$198.41
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$171.84
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$463.60
|
| Rate for Payer: Three Rivers Provider Network All |
$366.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$429.44
|
| Rate for Payer: United Healthcare Commercial |
$414.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$171.84
|
| Rate for Payer: United Payors & United Providers UP&UP |
$453.84
|
| Rate for Payer: Zelis Auto |
$195.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$244.00
|
| Rate for Payer: Zelis Worker's Compensation |
$134.93
|
|
|
PT EVAL MOD COMPLEX
|
Facility
|
IP
|
$488.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
4310021
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$133.22 |
| Max. Negotiated Rate |
$463.60 |
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cigna Commercial |
$414.80
|
| Rate for Payer: First Health Commercial |
$439.20
|
| Rate for Payer: First Health Workers Compensation |
$188.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$439.20
|
| Rate for Payer: GEHA Commercial |
$341.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$439.20
|
| Rate for Payer: Multiplan All |
$444.08
|
| Rate for Payer: OMNI Networks Commercial |
$341.60
|
| Rate for Payer: One Health Plan PPO/POS |
$439.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$463.60
|
| Rate for Payer: Three Rivers Provider Network All |
$366.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$453.84
|
| Rate for Payer: Zelis Auto |
$195.20
|
| Rate for Payer: Zelis Worker's Compensation |
$133.22
|
|
|
PT GAIT TRAIN EA 15 MIN
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
CPT 97116
|
| Hospital Charge Code |
4307096
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$39.22 |
| Max. Negotiated Rate |
$173.85 |
| 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 |
$109.80
|
| 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 |
$109.80
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cigna Commercial |
$155.55
|
| Rate for Payer: First Health Commercial |
$164.70
|
| Rate for Payer: First Health Workers Compensation |
$55.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$164.70
|
| Rate for Payer: GEHA Commercial |
$146.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$164.70
|
| Rate for Payer: Humana ChoiceCare |
$47.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$50.21
|
| Rate for Payer: Multiplan All |
$166.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$109.80
|
| Rate for Payer: OMNI Networks Commercial |
$128.10
|
| Rate for Payer: One Health Plan PPO/POS |
$164.70
|
| 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 |
$173.85
|
| Rate for Payer: Three Rivers Provider Network All |
$137.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$161.04
|
| Rate for Payer: United Healthcare Commercial |
$155.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$50.21
|
| Rate for Payer: United Payors & United Providers UP&UP |
$170.19
|
| Rate for Payer: Zelis Auto |
$73.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$91.50
|
| Rate for Payer: Zelis Worker's Compensation |
$39.22
|
|
|
PT GAIT TRAIN EA 15 MIN
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
CPT 97116
|
| Hospital Charge Code |
4307096
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$49.96 |
| Max. Negotiated Rate |
$173.85 |
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cigna Commercial |
$155.55
|
| Rate for Payer: First Health Commercial |
$164.70
|
| Rate for Payer: First Health Workers Compensation |
$70.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$164.70
|
| Rate for Payer: GEHA Commercial |
$128.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$164.70
|
| Rate for Payer: Multiplan All |
$166.53
|
| Rate for Payer: OMNI Networks Commercial |
$128.10
|
| Rate for Payer: One Health Plan PPO/POS |
$164.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$173.85
|
| Rate for Payer: Three Rivers Provider Network All |
$137.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$170.19
|
| Rate for Payer: Zelis Auto |
$73.20
|
| Rate for Payer: Zelis Worker's Compensation |
$49.96
|
|
|
PT GROUP PHYS THERAPY
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
4310010
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$24.28 |
| Max. Negotiated Rate |
$173.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$38.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$109.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$38.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$30.33
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cigna Commercial |
$155.55
|
| Rate for Payer: First Health Commercial |
$164.70
|
| Rate for Payer: First Health Workers Compensation |
$34.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$164.70
|
| Rate for Payer: GEHA Commercial |
$146.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$164.70
|
| Rate for Payer: Humana ChoiceCare |
$47.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$30.94
|
| Rate for Payer: Multiplan All |
$166.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$109.80
|
| Rate for Payer: OMNI Networks Commercial |
$128.10
|
| Rate for Payer: One Health Plan PPO/POS |
$164.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$35.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$30.94
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$173.85
|
| Rate for Payer: Three Rivers Provider Network All |
$137.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$161.04
|
| Rate for Payer: United Healthcare Commercial |
$155.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$30.94
|
| Rate for Payer: United Payors & United Providers UP&UP |
$170.19
|
| Rate for Payer: Zelis Auto |
$73.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$91.50
|
| Rate for Payer: Zelis Worker's Compensation |
$24.28
|
|
|
PT GROUP PHYS THERAPY
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
4310010
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$49.96 |
| Max. Negotiated Rate |
$173.85 |
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cigna Commercial |
$155.55
|
| Rate for Payer: First Health Commercial |
$164.70
|
| Rate for Payer: First Health Workers Compensation |
$70.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$164.70
|
| Rate for Payer: GEHA Commercial |
$128.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$164.70
|
| Rate for Payer: Multiplan All |
$166.53
|
| Rate for Payer: OMNI Networks Commercial |
$128.10
|
| Rate for Payer: One Health Plan PPO/POS |
$164.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$173.85
|
| Rate for Payer: Three Rivers Provider Network All |
$137.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$170.19
|
| Rate for Payer: Zelis Auto |
$73.20
|
| Rate for Payer: Zelis Worker's Compensation |
$49.96
|
|
|
pth (parathy hormo) intact REF015610
|
Facility
|
IP
|
$436.00
|
|
|
Service Code
|
CPT 83970
|
| Hospital Charge Code |
2233970
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.24 |
| Max. Negotiated Rate |
$414.20 |
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cigna Commercial |
$370.60
|
| Rate for Payer: First Health Commercial |
$392.40
|
| Rate for Payer: First Health Workers Compensation |
$68.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$392.40
|
| Rate for Payer: GEHA Commercial |
$305.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$392.40
|
| Rate for Payer: Multiplan All |
$396.76
|
| Rate for Payer: OMNI Networks Commercial |
$305.20
|
| Rate for Payer: One Health Plan PPO/POS |
$392.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$414.20
|
| Rate for Payer: Three Rivers Provider Network All |
$327.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$405.48
|
| Rate for Payer: Zelis Auto |
$174.40
|
| Rate for Payer: Zelis Worker's Compensation |
$48.24
|
|
|
pth (parathy hormo) intact REF015610
|
Facility
|
OP
|
$436.00
|
|
|
Service Code
|
CPT 83970
|
| Hospital Charge Code |
2233970
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$414.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$74.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$261.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$74.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$58.87
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$41.28
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cigna Commercial |
$370.60
|
| Rate for Payer: First Health Commercial |
$392.40
|
| Rate for Payer: First Health Workers Compensation |
$68.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$392.40
|
| Rate for Payer: GEHA Commercial |
$348.80
|
| Rate for Payer: GEHA Medicare |
$41.28
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$392.40
|
| Rate for Payer: Humana ChoiceCare |
$45.41
|
| Rate for Payer: Humana Medicare Advantage |
$41.28
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$69.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$60.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$41.28
|
| Rate for Payer: Multiplan All |
$396.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$70.18
|
| Rate for Payer: OMNI Networks Commercial |
$305.20
|
| Rate for Payer: One Health Plan PPO/POS |
$392.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$69.36
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$60.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$41.28
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$414.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$82.56
|
| Rate for Payer: Three Rivers Provider Network All |
$327.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$40.45
|
| Rate for Payer: United Healthcare Commercial |
$370.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$60.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41.28
|
| Rate for Payer: United Payors & United Providers UP&UP |
$405.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$41.28
|
| Rate for Payer: Zelis Auto |
$174.40
|
| Rate for Payer: Zelis Medicare |
$35.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$49.54
|
| Rate for Payer: Zelis Worker's Compensation |
$48.24
|
|
|
pth plus calcium REF054601
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT 82310
|
| Hospital Charge Code |
2200744
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$130.15 |
| 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 |
$8.88
|
| 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 |
$6.28
|
|
|
pth plus calcium REF054601
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT 82310
|
| Hospital Charge Code |
2200744
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.39 |
| Max. Negotiated Rate |
$130.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.29
|
| 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 |
$9.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.16
|
| 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 |
$8.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$123.30
|
| Rate for Payer: GEHA Commercial |
$109.60
|
| Rate for Payer: GEHA Medicare |
$5.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$123.30
|
| Rate for Payer: Humana ChoiceCare |
$5.68
|
| Rate for Payer: Humana Medicare Advantage |
$5.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.16
|
| Rate for Payer: Multiplan All |
$124.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.77
|
| 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 |
$8.67
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$130.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.32
|
| Rate for Payer: Three Rivers Provider Network All |
$102.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.06
|
| Rate for Payer: United Healthcare Commercial |
$116.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$127.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.16
|
| Rate for Payer: Zelis Auto |
$54.80
|
| Rate for Payer: Zelis Medicare |
$4.39
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.19
|
| Rate for Payer: Zelis Worker's Compensation |
$6.28
|
|
|
pth related peptide REF503380
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
2200300
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$25.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$149.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$25.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$20.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$14.12
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$224.10
|
| Rate for Payer: First Health Workers Compensation |
$22.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$224.10
|
| Rate for Payer: GEHA Commercial |
$199.20
|
| Rate for Payer: GEHA Medicare |
$14.12
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| Rate for Payer: Humana ChoiceCare |
$15.53
|
| Rate for Payer: Humana Medicare Advantage |
$14.12
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$23.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$20.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$14.12
|
| Rate for Payer: Multiplan All |
$226.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$24.00
|
| Rate for Payer: OMNI Networks Commercial |
$174.30
|
| Rate for Payer: One Health Plan PPO/POS |
$224.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$23.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$20.54
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$14.12
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$236.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$28.24
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$13.84
|
| Rate for Payer: United Healthcare Commercial |
$211.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$20.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.12
|
| Rate for Payer: United Payors & United Providers UP&UP |
$231.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$14.12
|
| Rate for Payer: Zelis Auto |
$99.60
|
| Rate for Payer: Zelis Medicare |
$12.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$16.94
|
| Rate for Payer: Zelis Worker's Compensation |
$15.81
|
|
|
pth related peptide REF503380
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
2200300
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.81 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$224.10
|
| Rate for Payer: First Health Workers Compensation |
$22.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$224.10
|
| Rate for Payer: GEHA Commercial |
$174.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| Rate for Payer: Multiplan All |
$226.59
|
| Rate for Payer: OMNI Networks Commercial |
$174.30
|
| Rate for Payer: One Health Plan PPO/POS |
$224.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$236.55
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$231.57
|
| Rate for Payer: Zelis Auto |
$99.60
|
| Rate for Payer: Zelis Worker's Compensation |
$15.81
|
|
|
PT IONTOPHORESIS EA 15
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
CPT 97033
|
| Hospital Charge Code |
4307098
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$51.32 |
| Max. Negotiated Rate |
$178.60 |
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cigna Commercial |
$159.80
|
| Rate for Payer: First Health Commercial |
$169.20
|
| Rate for Payer: First Health Workers Compensation |
$72.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$169.20
|
| Rate for Payer: GEHA Commercial |
$131.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$169.20
|
| Rate for Payer: Multiplan All |
$171.08
|
| Rate for Payer: OMNI Networks Commercial |
$131.60
|
| Rate for Payer: One Health Plan PPO/POS |
$169.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$178.60
|
| Rate for Payer: Three Rivers Provider Network All |
$141.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$174.84
|
| Rate for Payer: Zelis Auto |
$75.20
|
| Rate for Payer: Zelis Worker's Compensation |
$51.32
|
|
|
PT IONTOPHORESIS EA 15
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
CPT 97033
|
| Hospital Charge Code |
4307098
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$25.68 |
| Max. Negotiated Rate |
$178.60 |
| 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 |
$112.80
|
| 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 |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cigna Commercial |
$159.80
|
| Rate for Payer: First Health Commercial |
$169.20
|
| Rate for Payer: First Health Workers Compensation |
$36.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$169.20
|
| Rate for Payer: GEHA Commercial |
$150.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$169.20
|
| Rate for Payer: Humana ChoiceCare |
$48.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$32.94
|
| Rate for Payer: Multiplan All |
$171.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$112.80
|
| Rate for Payer: OMNI Networks Commercial |
$131.60
|
| Rate for Payer: One Health Plan PPO/POS |
$169.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$38.04
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$32.94
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$178.60
|
| Rate for Payer: Three Rivers Provider Network All |
$141.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$165.44
|
| Rate for Payer: United Healthcare Commercial |
$159.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$32.94
|
| Rate for Payer: United Payors & United Providers UP&UP |
$174.84
|
| Rate for Payer: Zelis Auto |
$75.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$94.00
|
| Rate for Payer: Zelis Worker's Compensation |
$25.68
|
|
|
PT LOW FREQ NON THERMAL US
|
Facility
|
OP
|
$528.00
|
|
|
Service Code
|
CPT 97610
|
| Hospital Charge Code |
4310019
|
|
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 |
$316.80
|
| 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: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cigna Commercial |
$448.80
|
| Rate for Payer: First Health Commercial |
$475.20
|
| Rate for Payer: First Health Workers Compensation |
$771.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$475.20
|
| Rate for Payer: GEHA Commercial |
$422.40
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$475.20
|
| 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 |
$94.17
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$480.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$369.60
|
| Rate for Payer: One Health Plan PPO/POS |
$475.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$108.74
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$94.17
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$501.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$396.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Commercial |
$448.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$94.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$491.04
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$211.20
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$545.80
|
|
|
PT LOW FREQ NON THERMAL US
|
Facility
|
IP
|
$528.00
|
|
|
Service Code
|
CPT 97610
|
| Hospital Charge Code |
4310019
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$144.14 |
| Max. Negotiated Rate |
$501.60 |
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cigna Commercial |
$448.80
|
| Rate for Payer: First Health Commercial |
$475.20
|
| Rate for Payer: First Health Workers Compensation |
$203.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$475.20
|
| Rate for Payer: GEHA Commercial |
$369.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$475.20
|
| Rate for Payer: Multiplan All |
$480.48
|
| Rate for Payer: OMNI Networks Commercial |
$369.60
|
| Rate for Payer: One Health Plan PPO/POS |
$475.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$501.60
|
| Rate for Payer: Three Rivers Provider Network All |
$396.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$491.04
|
| Rate for Payer: Zelis Auto |
$211.20
|
| Rate for Payer: Zelis Worker's Compensation |
$144.14
|
|
