|
PT MANUAL THERAPY
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
4310003
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$36.42 |
| Max. Negotiated Rate |
$193.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$57.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$122.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$57.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$45.39
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cigna Commercial |
$173.40
|
| Rate for Payer: First Health Commercial |
$183.60
|
| Rate for Payer: First Health Workers Compensation |
$51.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$183.60
|
| Rate for Payer: GEHA Commercial |
$163.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$183.60
|
| Rate for Payer: Humana ChoiceCare |
$53.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$46.32
|
| Rate for Payer: Multiplan All |
$185.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$122.40
|
| Rate for Payer: OMNI Networks Commercial |
$142.80
|
| Rate for Payer: One Health Plan PPO/POS |
$183.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$53.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$46.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$193.80
|
| Rate for Payer: Three Rivers Provider Network All |
$153.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$179.52
|
| Rate for Payer: United Healthcare Commercial |
$173.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$46.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$189.72
|
| Rate for Payer: Zelis Auto |
$81.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$102.00
|
| Rate for Payer: Zelis Worker's Compensation |
$36.42
|
|
|
PT MANUAL THERAPY
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
4310003
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$55.69 |
| Max. Negotiated Rate |
$193.80 |
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cigna Commercial |
$173.40
|
| Rate for Payer: First Health Commercial |
$183.60
|
| Rate for Payer: First Health Workers Compensation |
$78.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$183.60
|
| Rate for Payer: GEHA Commercial |
$142.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$183.60
|
| Rate for Payer: Multiplan All |
$185.64
|
| Rate for Payer: OMNI Networks Commercial |
$142.80
|
| Rate for Payer: One Health Plan PPO/POS |
$183.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$193.80
|
| Rate for Payer: Three Rivers Provider Network All |
$153.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$189.72
|
| Rate for Payer: Zelis Auto |
$81.60
|
| Rate for Payer: Zelis Worker's Compensation |
$55.69
|
|
|
PT MECHANICAL TRACTION
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
CPT 97012
|
| Hospital Charge Code |
4309030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.16 |
| Max. Negotiated Rate |
$162.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$21.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$102.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$21.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$17.16
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cigna Commercial |
$145.35
|
| Rate for Payer: First Health Commercial |
$153.90
|
| Rate for Payer: First Health Workers Compensation |
$27.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$153.90
|
| Rate for Payer: GEHA Commercial |
$136.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$153.90
|
| Rate for Payer: Humana ChoiceCare |
$44.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$17.51
|
| Rate for Payer: Multiplan All |
$155.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$102.60
|
| Rate for Payer: OMNI Networks Commercial |
$119.70
|
| Rate for Payer: One Health Plan PPO/POS |
$153.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$20.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$17.51
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$162.45
|
| Rate for Payer: Three Rivers Provider Network All |
$128.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$150.48
|
| Rate for Payer: United Healthcare Commercial |
$145.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17.51
|
| Rate for Payer: United Payors & United Providers UP&UP |
$159.03
|
| Rate for Payer: Zelis Auto |
$68.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$85.50
|
| Rate for Payer: Zelis Worker's Compensation |
$19.14
|
|
|
PT MECHANICAL TRACTION
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 97012
|
| Hospital Charge Code |
4309030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$46.68 |
| Max. Negotiated Rate |
$162.45 |
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cigna Commercial |
$145.35
|
| Rate for Payer: First Health Commercial |
$153.90
|
| Rate for Payer: First Health Workers Compensation |
$66.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$153.90
|
| Rate for Payer: GEHA Commercial |
$119.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$153.90
|
| Rate for Payer: Multiplan All |
$155.61
|
| Rate for Payer: OMNI Networks Commercial |
$119.70
|
| Rate for Payer: One Health Plan PPO/POS |
$153.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$162.45
|
| Rate for Payer: Three Rivers Provider Network All |
$128.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$159.03
|
| Rate for Payer: Zelis Auto |
$68.40
|
| Rate for Payer: Zelis Worker's Compensation |
$46.68
|
|
|
PT MUSCLE TESTING, EXTREMITY OR TRUNK
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
CPT 95831
|
| Hospital Charge Code |
4397022
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$216.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna Commercial |
$193.80
|
| Rate for Payer: First Health Commercial |
$205.20
|
| Rate for Payer: First Health Workers Compensation |
$88.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$205.20
|
| Rate for Payer: GEHA Commercial |
$182.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$205.20
|
| Rate for Payer: Humana ChoiceCare |
$59.28
|
| Rate for Payer: Multiplan All |
$207.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$136.80
|
| Rate for Payer: OMNI Networks Commercial |
$159.60
|
| Rate for Payer: One Health Plan PPO/POS |
$205.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$216.60
|
| Rate for Payer: Three Rivers Provider Network All |
$171.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$200.64
|
| Rate for Payer: United Healthcare Commercial |
$193.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$57.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$212.04
|
| Rate for Payer: Zelis Auto |
$91.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$114.00
|
| Rate for Payer: Zelis Worker's Compensation |
$62.24
|
|
|
PT MUSCLE TESTING, EXTREMITY OR TRUNK
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
CPT 95831
|
| Hospital Charge Code |
4397022
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$62.24 |
| Max. Negotiated Rate |
$216.60 |
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna Commercial |
$193.80
|
| Rate for Payer: First Health Commercial |
$205.20
|
| Rate for Payer: First Health Workers Compensation |
$88.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$205.20
|
| Rate for Payer: GEHA Commercial |
$159.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$205.20
|
| Rate for Payer: Multiplan All |
$207.48
|
| Rate for Payer: OMNI Networks Commercial |
$159.60
|
| Rate for Payer: One Health Plan PPO/POS |
$205.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$216.60
|
| Rate for Payer: Three Rivers Provider Network All |
$171.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$212.04
|
| Rate for Payer: Zelis Auto |
$91.20
|
| Rate for Payer: Zelis Worker's Compensation |
$62.24
|
|
|
PT MUSCLE TESTING, HAND
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT 95832
|
| Hospital Charge Code |
4397762
|
|
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
|
|
|
PT MUSCLE TESTING, HAND
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT 95832
|
| Hospital Charge Code |
4397762
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$44.25 |
| Max. Negotiated Rate |
$168.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$106.20
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cigna Commercial |
$150.45
|
| Rate for Payer: First Health Commercial |
$159.30
|
| Rate for Payer: First Health Workers Compensation |
$68.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$159.30
|
| Rate for Payer: GEHA Commercial |
$141.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$159.30
|
| Rate for Payer: Humana ChoiceCare |
$46.02
|
| Rate for Payer: Multiplan All |
$161.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$106.20
|
| Rate for Payer: OMNI Networks Commercial |
$123.90
|
| Rate for Payer: One Health Plan PPO/POS |
$159.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$168.15
|
| Rate for Payer: Three Rivers Provider Network All |
$132.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$155.76
|
| Rate for Payer: United Healthcare Commercial |
$150.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$44.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$164.61
|
| Rate for Payer: Zelis Auto |
$70.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$88.50
|
| Rate for Payer: Zelis Worker's Compensation |
$48.32
|
|
|
PT MUSCLE TESTING, TOTAL EVALUATION OF B
|
Facility
|
OP
|
$354.00
|
|
|
Service Code
|
CPT 95834
|
| Hospital Charge Code |
4397799
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$88.50 |
| Max. Negotiated Rate |
$336.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$212.40
|
| Rate for Payer: Cash Price |
$212.40
|
| Rate for Payer: Cigna Commercial |
$300.90
|
| Rate for Payer: First Health Commercial |
$318.60
|
| Rate for Payer: First Health Workers Compensation |
$136.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$318.60
|
| Rate for Payer: GEHA Commercial |
$283.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$318.60
|
| Rate for Payer: Humana ChoiceCare |
$92.04
|
| Rate for Payer: Multiplan All |
$322.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$212.40
|
| Rate for Payer: OMNI Networks Commercial |
$247.80
|
| Rate for Payer: One Health Plan PPO/POS |
$318.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$336.30
|
| Rate for Payer: Three Rivers Provider Network All |
$265.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$311.52
|
| Rate for Payer: United Healthcare Commercial |
$300.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$88.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$329.22
|
| Rate for Payer: Zelis Auto |
$141.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$177.00
|
| Rate for Payer: Zelis Worker's Compensation |
$96.64
|
|
|
PT MUSCLE TESTING, TOTAL EVALUATION OF B
|
Facility
|
IP
|
$354.00
|
|
|
Service Code
|
CPT 95834
|
| Hospital Charge Code |
4397799
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$96.64 |
| Max. Negotiated Rate |
$336.30 |
| Rate for Payer: Cash Price |
$212.40
|
| Rate for Payer: Cigna Commercial |
$300.90
|
| Rate for Payer: First Health Commercial |
$318.60
|
| Rate for Payer: First Health Workers Compensation |
$136.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$318.60
|
| Rate for Payer: GEHA Commercial |
$247.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$318.60
|
| Rate for Payer: Multiplan All |
$322.14
|
| Rate for Payer: OMNI Networks Commercial |
$247.80
|
| Rate for Payer: One Health Plan PPO/POS |
$318.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$336.30
|
| Rate for Payer: Three Rivers Provider Network All |
$265.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$329.22
|
| Rate for Payer: Zelis Auto |
$141.60
|
| Rate for Payer: Zelis Worker's Compensation |
$96.64
|
|
|
PT NEEDLE INSER W/O INJEC 1 OR 2 MUSCLES
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
CPT 20560
|
| Hospital Charge Code |
4320560
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.76 |
| Max. Negotiated Rate |
$76.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$34.48
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$48.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$34.48
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$27.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$23.25
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$68.85
|
| Rate for Payer: First Health Commercial |
$72.90
|
| Rate for Payer: First Health Workers Compensation |
$31.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$72.90
|
| Rate for Payer: GEHA Commercial |
$64.80
|
| Rate for Payer: GEHA Medicare |
$23.25
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$72.90
|
| Rate for Payer: Humana ChoiceCare |
$25.57
|
| Rate for Payer: Humana Medicare Advantage |
$23.25
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$39.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$27.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$23.25
|
| Rate for Payer: Multiplan All |
$73.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$39.52
|
| Rate for Payer: OMNI Networks Commercial |
$56.70
|
| Rate for Payer: One Health Plan PPO/POS |
$72.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$32.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$27.88
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$23.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$76.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$46.50
|
| Rate for Payer: Three Rivers Provider Network All |
$60.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$22.79
|
| Rate for Payer: United Healthcare Commercial |
$68.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$27.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$75.33
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$23.25
|
| Rate for Payer: Zelis Auto |
$32.40
|
| Rate for Payer: Zelis Medicare |
$19.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$27.90
|
| Rate for Payer: Zelis Worker's Compensation |
$22.11
|
|
|
PT NEEDLE INSER W/O INJEC 1 OR 2 MUSCLES
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
CPT 20560
|
| Hospital Charge Code |
4320560
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$76.95 |
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$68.85
|
| Rate for Payer: First Health Commercial |
$72.90
|
| Rate for Payer: First Health Workers Compensation |
$31.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$72.90
|
| Rate for Payer: GEHA Commercial |
$56.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$72.90
|
| Rate for Payer: Multiplan All |
$73.71
|
| Rate for Payer: OMNI Networks Commercial |
$56.70
|
| Rate for Payer: One Health Plan PPO/POS |
$72.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$76.95
|
| Rate for Payer: Three Rivers Provider Network All |
$60.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$75.33
|
| Rate for Payer: Zelis Auto |
$32.40
|
| Rate for Payer: Zelis Worker's Compensation |
$22.11
|
|
|
PT NEEDLE INSER W/O INJECT 3/> MUSCLES
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
CPT 20561
|
| Hospital Charge Code |
4320561
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.76 |
| Max. Negotiated Rate |
$88.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$34.48
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$55.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$34.48
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$27.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$23.25
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$79.05
|
| Rate for Payer: First Health Commercial |
$83.70
|
| Rate for Payer: First Health Workers Compensation |
$35.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$83.70
|
| Rate for Payer: GEHA Commercial |
$74.40
|
| Rate for Payer: GEHA Medicare |
$23.25
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$83.70
|
| Rate for Payer: Humana ChoiceCare |
$25.57
|
| Rate for Payer: Humana Medicare Advantage |
$23.25
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$39.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$27.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$23.25
|
| Rate for Payer: Multiplan All |
$84.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$39.52
|
| Rate for Payer: OMNI Networks Commercial |
$65.10
|
| Rate for Payer: One Health Plan PPO/POS |
$83.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$32.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$27.88
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$23.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$88.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$46.50
|
| Rate for Payer: Three Rivers Provider Network All |
$69.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$22.79
|
| Rate for Payer: United Healthcare Commercial |
$79.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$27.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$86.49
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$23.25
|
| Rate for Payer: Zelis Auto |
$37.20
|
| Rate for Payer: Zelis Medicare |
$19.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$27.90
|
| Rate for Payer: Zelis Worker's Compensation |
$25.39
|
|
|
PT NEEDLE INSER W/O INJECT 3/> MUSCLES
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
CPT 20561
|
| Hospital Charge Code |
4320561
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$25.39 |
| Max. Negotiated Rate |
$88.35 |
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$79.05
|
| Rate for Payer: First Health Commercial |
$83.70
|
| Rate for Payer: First Health Workers Compensation |
$35.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$83.70
|
| Rate for Payer: GEHA Commercial |
$65.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$83.70
|
| Rate for Payer: Multiplan All |
$84.63
|
| Rate for Payer: OMNI Networks Commercial |
$65.10
|
| Rate for Payer: One Health Plan PPO/POS |
$83.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$88.35
|
| Rate for Payer: Three Rivers Provider Network All |
$69.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$86.49
|
| Rate for Payer: Zelis Auto |
$37.20
|
| Rate for Payer: Zelis Worker's Compensation |
$25.39
|
|
|
PT NEG PRESSURE </=50 CM
|
Facility
|
IP
|
$954.00
|
|
|
Service Code
|
CPT 97607
|
| Hospital Charge Code |
4310017
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$260.44 |
| Max. Negotiated Rate |
$906.30 |
| Rate for Payer: Cash Price |
$572.40
|
| Rate for Payer: Cigna Commercial |
$810.90
|
| Rate for Payer: First Health Commercial |
$858.60
|
| Rate for Payer: First Health Workers Compensation |
$368.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$858.60
|
| Rate for Payer: GEHA Commercial |
$667.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$858.60
|
| Rate for Payer: Multiplan All |
$868.14
|
| Rate for Payer: OMNI Networks Commercial |
$667.80
|
| Rate for Payer: One Health Plan PPO/POS |
$858.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$906.30
|
| Rate for Payer: Three Rivers Provider Network All |
$715.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$887.22
|
| Rate for Payer: Zelis Auto |
$381.60
|
| Rate for Payer: Zelis Worker's Compensation |
$260.44
|
|
|
PT NEG PRESSURE </=50 CM
|
Facility
|
OP
|
$954.00
|
|
|
Service Code
|
CPT 97607
|
| Hospital Charge Code |
4310017
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$173.59 |
| Max. Negotiated Rate |
$906.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$219.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$572.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$219.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$173.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$379.37
|
| Rate for Payer: Cash Price |
$572.40
|
| Rate for Payer: Cash Price |
$572.40
|
| Rate for Payer: Cigna Commercial |
$810.90
|
| Rate for Payer: First Health Commercial |
$858.60
|
| Rate for Payer: First Health Workers Compensation |
$629.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$858.60
|
| Rate for Payer: GEHA Commercial |
$763.20
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$858.60
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$177.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$868.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$667.80
|
| Rate for Payer: One Health Plan PPO/POS |
$858.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$204.51
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$177.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$906.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$715.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Commercial |
$810.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$177.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$887.22
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$381.60
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$445.42
|
|
|
PT NEG PRESSURE <50CM
|
Facility
|
OP
|
$561.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
4310015
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$56.96 |
| Max. Negotiated Rate |
$532.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$336.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$336.60
|
| Rate for Payer: Cash Price |
$336.60
|
| Rate for Payer: Cigna Commercial |
$476.85
|
| Rate for Payer: First Health Commercial |
$504.90
|
| Rate for Payer: First Health Workers Compensation |
$80.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$504.90
|
| Rate for Payer: GEHA Commercial |
$448.80
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$504.90
|
| 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 |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$510.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$392.70
|
| Rate for Payer: One Health Plan PPO/POS |
$504.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$532.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$420.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Commercial |
$476.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$521.73
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$224.40
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$56.96
|
|
|
PT NEG PRESSURE <50CM
|
Facility
|
IP
|
$561.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
4310015
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$153.15 |
| Max. Negotiated Rate |
$532.95 |
| Rate for Payer: Cash Price |
$336.60
|
| Rate for Payer: Cigna Commercial |
$476.85
|
| Rate for Payer: First Health Commercial |
$504.90
|
| Rate for Payer: First Health Workers Compensation |
$216.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$504.90
|
| Rate for Payer: GEHA Commercial |
$392.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$504.90
|
| Rate for Payer: Multiplan All |
$510.51
|
| Rate for Payer: OMNI Networks Commercial |
$392.70
|
| Rate for Payer: One Health Plan PPO/POS |
$504.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$532.95
|
| Rate for Payer: Three Rivers Provider Network All |
$420.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$521.73
|
| Rate for Payer: Zelis Auto |
$224.40
|
| Rate for Payer: Zelis Worker's Compensation |
$153.15
|
|
|
PT NEG PRESSURE >50 CM
|
Facility
|
OP
|
$866.00
|
|
|
Service Code
|
CPT 97606
|
| Hospital Charge Code |
4310016
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$67.70 |
| Max. Negotiated Rate |
$822.70 |
| 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 |
$519.60
|
| 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 |
$379.37
|
| Rate for Payer: Cash Price |
$519.60
|
| Rate for Payer: Cash Price |
$519.60
|
| Rate for Payer: Cigna Commercial |
$736.10
|
| Rate for Payer: First Health Commercial |
$779.40
|
| Rate for Payer: First Health Workers Compensation |
$95.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$779.40
|
| Rate for Payer: GEHA Commercial |
$692.80
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$779.40
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$125.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$788.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$606.20
|
| Rate for Payer: One Health Plan PPO/POS |
$779.40
|
| 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 |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$822.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$649.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Commercial |
$736.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$125.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$805.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$346.40
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$67.70
|
|
|
PT NEG PRESSURE >50 CM
|
Facility
|
IP
|
$866.00
|
|
|
Service Code
|
CPT 97606
|
| Hospital Charge Code |
4310016
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$236.42 |
| Max. Negotiated Rate |
$822.70 |
| Rate for Payer: Cash Price |
$519.60
|
| Rate for Payer: Cigna Commercial |
$736.10
|
| Rate for Payer: First Health Commercial |
$779.40
|
| Rate for Payer: First Health Workers Compensation |
$334.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$779.40
|
| Rate for Payer: GEHA Commercial |
$606.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$779.40
|
| Rate for Payer: Multiplan All |
$788.06
|
| Rate for Payer: OMNI Networks Commercial |
$606.20
|
| Rate for Payer: One Health Plan PPO/POS |
$779.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$822.70
|
| Rate for Payer: Three Rivers Provider Network All |
$649.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$805.38
|
| Rate for Payer: Zelis Auto |
$346.40
|
| Rate for Payer: Zelis Worker's Compensation |
$236.42
|
|
|
PT NEG PRESSURE >50CM
|
Facility
|
OP
|
$1,512.00
|
|
|
Service Code
|
CPT 97608
|
| Hospital Charge Code |
4310018
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$268.02 |
| Max. Negotiated Rate |
$1,436.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$338.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$907.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$338.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$268.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$379.37
|
| Rate for Payer: Cash Price |
$907.20
|
| Rate for Payer: Cash Price |
$907.20
|
| Rate for Payer: Cigna Commercial |
$1,285.20
|
| Rate for Payer: First Health Commercial |
$1,360.80
|
| Rate for Payer: First Health Workers Compensation |
$652.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,360.80
|
| Rate for Payer: GEHA Commercial |
$1,209.60
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,360.80
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$273.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$1,375.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,058.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,360.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$315.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$273.48
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,436.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$1,134.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Commercial |
$1,285.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$273.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,406.16
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$604.80
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$461.30
|
|
|
PT NEG PRESSURE >50CM
|
Facility
|
IP
|
$1,512.00
|
|
|
Service Code
|
CPT 97608
|
| Hospital Charge Code |
4310018
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$412.78 |
| Max. Negotiated Rate |
$1,436.40 |
| Rate for Payer: Cash Price |
$907.20
|
| Rate for Payer: Cigna Commercial |
$1,285.20
|
| Rate for Payer: First Health Commercial |
$1,360.80
|
| Rate for Payer: First Health Workers Compensation |
$583.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,360.80
|
| Rate for Payer: GEHA Commercial |
$1,058.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,360.80
|
| Rate for Payer: Multiplan All |
$1,375.92
|
| Rate for Payer: OMNI Networks Commercial |
$1,058.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,360.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,436.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,134.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,406.16
|
| Rate for Payer: Zelis Auto |
$604.80
|
| Rate for Payer: Zelis Worker's Compensation |
$412.78
|
|
|
PT NEUROMUSC REED EA 15
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
CPT 97112
|
| Hospital Charge Code |
4307032
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$45.29 |
| Max. Negotiated Rate |
$189.05 |
| 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 |
$119.40
|
| 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 |
$119.40
|
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cigna Commercial |
$169.15
|
| Rate for Payer: First Health Commercial |
$179.10
|
| Rate for Payer: First Health Workers Compensation |
$64.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$179.10
|
| Rate for Payer: GEHA Commercial |
$159.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$179.10
|
| Rate for Payer: Humana ChoiceCare |
$51.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$57.51
|
| Rate for Payer: Multiplan All |
$181.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$119.40
|
| Rate for Payer: OMNI Networks Commercial |
$139.30
|
| Rate for Payer: One Health Plan PPO/POS |
$179.10
|
| 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 |
$189.05
|
| Rate for Payer: Three Rivers Provider Network All |
$149.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$175.12
|
| Rate for Payer: United Healthcare Commercial |
$169.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$57.51
|
| Rate for Payer: United Payors & United Providers UP&UP |
$185.07
|
| Rate for Payer: Zelis Auto |
$79.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$99.50
|
| Rate for Payer: Zelis Worker's Compensation |
$45.29
|
|
|
PT NEUROMUSC REED EA 15
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
CPT 97112
|
| Hospital Charge Code |
4307032
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$54.33 |
| Max. Negotiated Rate |
$189.05 |
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cigna Commercial |
$169.15
|
| Rate for Payer: First Health Commercial |
$179.10
|
| Rate for Payer: First Health Workers Compensation |
$76.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$179.10
|
| Rate for Payer: GEHA Commercial |
$139.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$179.10
|
| Rate for Payer: Multiplan All |
$181.09
|
| Rate for Payer: OMNI Networks Commercial |
$139.30
|
| Rate for Payer: One Health Plan PPO/POS |
$179.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$189.05
|
| Rate for Payer: Three Rivers Provider Network All |
$149.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$185.07
|
| Rate for Payer: Zelis Auto |
$79.60
|
| Rate for Payer: Zelis Worker's Compensation |
$54.33
|
|
|
PT ORTHOTIC TRNG 15MIN
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
CPT 97760
|
| Hospital Charge Code |
4307703
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$53.78 |
| Max. Negotiated Rate |
$187.15 |
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cigna Commercial |
$167.45
|
| Rate for Payer: First Health Commercial |
$177.30
|
| Rate for Payer: First Health Workers Compensation |
$76.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$177.30
|
| Rate for Payer: GEHA Commercial |
$137.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$177.30
|
| Rate for Payer: Multiplan All |
$179.27
|
| Rate for Payer: OMNI Networks Commercial |
$137.90
|
| Rate for Payer: One Health Plan PPO/POS |
$177.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$187.15
|
| Rate for Payer: Three Rivers Provider Network All |
$147.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$183.21
|
| Rate for Payer: Zelis Auto |
$78.80
|
| Rate for Payer: Zelis Worker's Compensation |
$53.78
|
|
