|
REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 99454
|
| Hospital Charge Code |
9399219
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.10 |
| Max. Negotiated Rate |
$171.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$108.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$35.41
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cigna Commercial |
$153.85
|
| Rate for Payer: First Health Commercial |
$162.90
|
| Rate for Payer: First Health Workers Compensation |
$69.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$162.90
|
| Rate for Payer: GEHA Commercial |
$144.80
|
| Rate for Payer: GEHA Medicare |
$35.41
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$162.90
|
| Rate for Payer: Humana ChoiceCare |
$38.95
|
| Rate for Payer: Humana Medicare Advantage |
$35.41
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$59.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$35.41
|
| Rate for Payer: Multiplan All |
$164.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$60.20
|
| Rate for Payer: OMNI Networks Commercial |
$126.70
|
| Rate for Payer: One Health Plan PPO/POS |
$162.90
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$35.41
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$171.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$70.82
|
| Rate for Payer: Three Rivers Provider Network All |
$135.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$34.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$45.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.41
|
| Rate for Payer: United Payors & United Providers UP&UP |
$168.33
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$35.41
|
| Rate for Payer: Zelis Auto |
$72.40
|
| Rate for Payer: Zelis Medicare |
$30.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$42.49
|
| Rate for Payer: Zelis Worker's Compensation |
$49.41
|
|
|
REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 99454
|
| Hospital Charge Code |
9400097
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.41 |
| Max. Negotiated Rate |
$171.95 |
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cigna Commercial |
$153.85
|
| Rate for Payer: First Health Commercial |
$162.90
|
| Rate for Payer: First Health Workers Compensation |
$69.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$162.90
|
| Rate for Payer: GEHA Commercial |
$126.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$162.90
|
| Rate for Payer: Multiplan All |
$164.71
|
| Rate for Payer: OMNI Networks Commercial |
$126.70
|
| Rate for Payer: One Health Plan PPO/POS |
$162.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$171.95
|
| Rate for Payer: Three Rivers Provider Network All |
$135.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$168.33
|
| Rate for Payer: Zelis Auto |
$72.40
|
| Rate for Payer: Zelis Worker's Compensation |
$49.41
|
|
|
REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 99454
|
| Hospital Charge Code |
9599221
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$49.41 |
| Max. Negotiated Rate |
$171.95 |
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cigna Commercial |
$153.85
|
| Rate for Payer: First Health Commercial |
$162.90
|
| Rate for Payer: First Health Workers Compensation |
$69.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$162.90
|
| Rate for Payer: GEHA Commercial |
$126.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$162.90
|
| Rate for Payer: Multiplan All |
$164.71
|
| Rate for Payer: OMNI Networks Commercial |
$126.70
|
| Rate for Payer: One Health Plan PPO/POS |
$162.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$171.95
|
| Rate for Payer: Three Rivers Provider Network All |
$135.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$168.33
|
| Rate for Payer: Zelis Auto |
$72.40
|
| Rate for Payer: Zelis Worker's Compensation |
$49.41
|
|
|
REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA
|
Professional
|
Both
|
$181.00
|
|
|
Service Code
|
CPT 99454
|
| Hospital Charge Code |
10099219
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$33.28 |
| Max. Negotiated Rate |
$171.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$55.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$55.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$39.15
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cigna Commercial |
$108.60
|
| Rate for Payer: Cimarron Advantage Cimarron Advantage PPO |
$54.81
|
| Rate for Payer: First Health Workers Compensation |
$77.70
|
| Rate for Payer: GEHA Commercial |
$39.15
|
| Rate for Payer: GEHA Medicare |
$39.15
|
| Rate for Payer: Health Net Federal Services Government |
$39.15
|
| Rate for Payer: HealthSmart Commercial |
$54.81
|
| Rate for Payer: HealthSmart Worker's Compensation |
$74.56
|
| Rate for Payer: Humana ChoiceCare |
$43.06
|
| Rate for Payer: Humana Medicare Advantage |
$39.15
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$54.81
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$39.15
|
| Rate for Payer: Multiplan All |
$135.75
|
| Rate for Payer: National Preferred Provider Network Commercial |
$171.95
|
| Rate for Payer: National Preferred Provider Network Worker's Compensation |
$78.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$41.11
|
| Rate for Payer: OMNI Networks Commercial |
$126.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$65.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$50.01
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$84.96
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$38.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.15
|
| Rate for Payer: Zelis Medicare |
$33.28
|
| Rate for Payer: Zelis Worker's Compensation |
$54.94
|
|
|
REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 99454
|
| Hospital Charge Code |
7599219
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.41 |
| Max. Negotiated Rate |
$171.95 |
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cigna Commercial |
$153.85
|
| Rate for Payer: First Health Commercial |
$162.90
|
| Rate for Payer: First Health Workers Compensation |
$69.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$162.90
|
| Rate for Payer: GEHA Commercial |
$126.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$162.90
|
| Rate for Payer: Multiplan All |
$164.71
|
| Rate for Payer: OMNI Networks Commercial |
$126.70
|
| Rate for Payer: One Health Plan PPO/POS |
$162.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$171.95
|
| Rate for Payer: Three Rivers Provider Network All |
$135.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$168.33
|
| Rate for Payer: Zelis Auto |
$72.40
|
| Rate for Payer: Zelis Worker's Compensation |
$49.41
|
|
|
REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 99454
|
| Hospital Charge Code |
7599219
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.10 |
| Max. Negotiated Rate |
$171.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$108.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$35.41
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cigna Commercial |
$153.85
|
| Rate for Payer: First Health Commercial |
$162.90
|
| Rate for Payer: First Health Workers Compensation |
$69.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$162.90
|
| Rate for Payer: GEHA Commercial |
$144.80
|
| Rate for Payer: GEHA Medicare |
$35.41
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$162.90
|
| Rate for Payer: Humana ChoiceCare |
$38.95
|
| Rate for Payer: Humana Medicare Advantage |
$35.41
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$59.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$35.41
|
| Rate for Payer: Multiplan All |
$164.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$60.20
|
| Rate for Payer: OMNI Networks Commercial |
$126.70
|
| Rate for Payer: One Health Plan PPO/POS |
$162.90
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$35.41
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$171.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$70.82
|
| Rate for Payer: Three Rivers Provider Network All |
$135.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$34.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$45.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.41
|
| Rate for Payer: United Payors & United Providers UP&UP |
$168.33
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$35.41
|
| Rate for Payer: Zelis Auto |
$72.40
|
| Rate for Payer: Zelis Medicare |
$30.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$42.49
|
| Rate for Payer: Zelis Worker's Compensation |
$49.41
|
|
|
REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 99454
|
| Hospital Charge Code |
9400097
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.10 |
| Max. Negotiated Rate |
$171.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$108.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$35.41
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cigna Commercial |
$153.85
|
| Rate for Payer: First Health Commercial |
$162.90
|
| Rate for Payer: First Health Workers Compensation |
$69.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$162.90
|
| Rate for Payer: GEHA Commercial |
$144.80
|
| Rate for Payer: GEHA Medicare |
$35.41
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$162.90
|
| Rate for Payer: Humana ChoiceCare |
$38.95
|
| Rate for Payer: Humana Medicare Advantage |
$35.41
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$59.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$35.41
|
| Rate for Payer: Multiplan All |
$164.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$60.20
|
| Rate for Payer: OMNI Networks Commercial |
$126.70
|
| Rate for Payer: One Health Plan PPO/POS |
$162.90
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$35.41
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$171.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$70.82
|
| Rate for Payer: Three Rivers Provider Network All |
$135.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$34.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$45.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.41
|
| Rate for Payer: United Payors & United Providers UP&UP |
$168.33
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$35.41
|
| Rate for Payer: Zelis Auto |
$72.40
|
| Rate for Payer: Zelis Medicare |
$30.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$42.49
|
| Rate for Payer: Zelis Worker's Compensation |
$49.41
|
|
|
REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 99454
|
| Hospital Charge Code |
20399222
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$49.41 |
| Max. Negotiated Rate |
$171.95 |
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cigna Commercial |
$153.85
|
| Rate for Payer: First Health Commercial |
$162.90
|
| Rate for Payer: First Health Workers Compensation |
$69.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$162.90
|
| Rate for Payer: GEHA Commercial |
$126.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$162.90
|
| Rate for Payer: Multiplan All |
$164.71
|
| Rate for Payer: OMNI Networks Commercial |
$126.70
|
| Rate for Payer: One Health Plan PPO/POS |
$162.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$171.95
|
| Rate for Payer: Three Rivers Provider Network All |
$135.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$168.33
|
| Rate for Payer: Zelis Auto |
$72.40
|
| Rate for Payer: Zelis Worker's Compensation |
$49.41
|
|
|
REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 99454
|
| Hospital Charge Code |
21000005
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.41 |
| Max. Negotiated Rate |
$171.95 |
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cigna Commercial |
$153.85
|
| Rate for Payer: First Health Commercial |
$162.90
|
| Rate for Payer: First Health Workers Compensation |
$69.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$162.90
|
| Rate for Payer: GEHA Commercial |
$126.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$162.90
|
| Rate for Payer: Multiplan All |
$164.71
|
| Rate for Payer: OMNI Networks Commercial |
$126.70
|
| Rate for Payer: One Health Plan PPO/POS |
$162.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$171.95
|
| Rate for Payer: Three Rivers Provider Network All |
$135.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$168.33
|
| Rate for Payer: Zelis Auto |
$72.40
|
| Rate for Payer: Zelis Worker's Compensation |
$49.41
|
|
|
REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 99454
|
| Hospital Charge Code |
21000005
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.10 |
| Max. Negotiated Rate |
$171.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$108.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$35.41
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cigna Commercial |
$153.85
|
| Rate for Payer: First Health Commercial |
$162.90
|
| Rate for Payer: First Health Workers Compensation |
$69.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$162.90
|
| Rate for Payer: GEHA Commercial |
$144.80
|
| Rate for Payer: GEHA Medicare |
$35.41
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$162.90
|
| Rate for Payer: Humana ChoiceCare |
$38.95
|
| Rate for Payer: Humana Medicare Advantage |
$35.41
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$59.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$35.41
|
| Rate for Payer: Multiplan All |
$164.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$60.20
|
| Rate for Payer: OMNI Networks Commercial |
$126.70
|
| Rate for Payer: One Health Plan PPO/POS |
$162.90
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$35.41
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$171.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$70.82
|
| Rate for Payer: Three Rivers Provider Network All |
$135.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$34.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$45.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.41
|
| Rate for Payer: United Payors & United Providers UP&UP |
$168.33
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$35.41
|
| Rate for Payer: Zelis Auto |
$72.40
|
| Rate for Payer: Zelis Medicare |
$30.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$42.49
|
| Rate for Payer: Zelis Worker's Compensation |
$49.41
|
|
|
REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 99454
|
| Hospital Charge Code |
8000008
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.10 |
| Max. Negotiated Rate |
$171.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$108.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$35.41
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cigna Commercial |
$153.85
|
| Rate for Payer: First Health Commercial |
$162.90
|
| Rate for Payer: First Health Workers Compensation |
$69.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$162.90
|
| Rate for Payer: GEHA Commercial |
$144.80
|
| Rate for Payer: GEHA Medicare |
$35.41
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$162.90
|
| Rate for Payer: Humana ChoiceCare |
$38.95
|
| Rate for Payer: Humana Medicare Advantage |
$35.41
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$59.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$35.41
|
| Rate for Payer: Multiplan All |
$164.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$60.20
|
| Rate for Payer: OMNI Networks Commercial |
$126.70
|
| Rate for Payer: One Health Plan PPO/POS |
$162.90
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$35.41
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$171.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$70.82
|
| Rate for Payer: Three Rivers Provider Network All |
$135.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$34.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$45.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.41
|
| Rate for Payer: United Payors & United Providers UP&UP |
$168.33
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$35.41
|
| Rate for Payer: Zelis Auto |
$72.40
|
| Rate for Payer: Zelis Medicare |
$30.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$42.49
|
| Rate for Payer: Zelis Worker's Compensation |
$49.41
|
|
|
REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 99454
|
| Hospital Charge Code |
8000008
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.41 |
| Max. Negotiated Rate |
$171.95 |
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cigna Commercial |
$153.85
|
| Rate for Payer: First Health Commercial |
$162.90
|
| Rate for Payer: First Health Workers Compensation |
$69.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$162.90
|
| Rate for Payer: GEHA Commercial |
$126.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$162.90
|
| Rate for Payer: Multiplan All |
$164.71
|
| Rate for Payer: OMNI Networks Commercial |
$126.70
|
| Rate for Payer: One Health Plan PPO/POS |
$162.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$171.95
|
| Rate for Payer: Three Rivers Provider Network All |
$135.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$168.33
|
| Rate for Payer: Zelis Auto |
$72.40
|
| Rate for Payer: Zelis Worker's Compensation |
$49.41
|
|
|
REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 99454
|
| Hospital Charge Code |
9000029
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$49.41 |
| Max. Negotiated Rate |
$171.95 |
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cigna Commercial |
$153.85
|
| Rate for Payer: First Health Commercial |
$162.90
|
| Rate for Payer: First Health Workers Compensation |
$69.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$162.90
|
| Rate for Payer: GEHA Commercial |
$126.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$162.90
|
| Rate for Payer: Multiplan All |
$164.71
|
| Rate for Payer: OMNI Networks Commercial |
$126.70
|
| Rate for Payer: One Health Plan PPO/POS |
$162.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$171.95
|
| Rate for Payer: Three Rivers Provider Network All |
$135.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$168.33
|
| Rate for Payer: Zelis Auto |
$72.40
|
| Rate for Payer: Zelis Worker's Compensation |
$49.41
|
|
|
REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 99454
|
| Hospital Charge Code |
8300071
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$30.10 |
| Max. Negotiated Rate |
$171.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$108.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$35.41
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cigna Commercial |
$153.85
|
| Rate for Payer: First Health Commercial |
$162.90
|
| Rate for Payer: First Health Workers Compensation |
$69.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$162.90
|
| Rate for Payer: GEHA Commercial |
$144.80
|
| Rate for Payer: GEHA Medicare |
$35.41
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$162.90
|
| Rate for Payer: Humana ChoiceCare |
$38.95
|
| Rate for Payer: Humana Medicare Advantage |
$35.41
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$59.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$35.41
|
| Rate for Payer: Multiplan All |
$164.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$60.20
|
| Rate for Payer: OMNI Networks Commercial |
$126.70
|
| Rate for Payer: One Health Plan PPO/POS |
$162.90
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$35.41
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$171.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$70.82
|
| Rate for Payer: Three Rivers Provider Network All |
$135.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$34.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$45.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.41
|
| Rate for Payer: United Payors & United Providers UP&UP |
$168.33
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$35.41
|
| Rate for Payer: Zelis Auto |
$72.40
|
| Rate for Payer: Zelis Medicare |
$30.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$42.49
|
| Rate for Payer: Zelis Worker's Compensation |
$49.41
|
|
|
REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 99454
|
| Hospital Charge Code |
9200030
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$30.10 |
| Max. Negotiated Rate |
$171.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$108.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$35.41
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cigna Commercial |
$153.85
|
| Rate for Payer: First Health Commercial |
$162.90
|
| Rate for Payer: First Health Workers Compensation |
$69.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$162.90
|
| Rate for Payer: GEHA Commercial |
$144.80
|
| Rate for Payer: GEHA Medicare |
$35.41
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$162.90
|
| Rate for Payer: Humana ChoiceCare |
$38.95
|
| Rate for Payer: Humana Medicare Advantage |
$35.41
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$59.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$35.41
|
| Rate for Payer: Multiplan All |
$164.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$60.20
|
| Rate for Payer: OMNI Networks Commercial |
$126.70
|
| Rate for Payer: One Health Plan PPO/POS |
$162.90
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$35.41
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$171.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$70.82
|
| Rate for Payer: Three Rivers Provider Network All |
$135.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$34.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$45.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.41
|
| Rate for Payer: United Payors & United Providers UP&UP |
$168.33
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$35.41
|
| Rate for Payer: Zelis Auto |
$72.40
|
| Rate for Payer: Zelis Medicare |
$30.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$42.49
|
| Rate for Payer: Zelis Worker's Compensation |
$49.41
|
|
|
REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 99454
|
| Hospital Charge Code |
8250029
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$49.41 |
| Max. Negotiated Rate |
$171.95 |
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cigna Commercial |
$153.85
|
| Rate for Payer: First Health Commercial |
$162.90
|
| Rate for Payer: First Health Workers Compensation |
$69.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$162.90
|
| Rate for Payer: GEHA Commercial |
$126.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$162.90
|
| Rate for Payer: Multiplan All |
$164.71
|
| Rate for Payer: OMNI Networks Commercial |
$126.70
|
| Rate for Payer: One Health Plan PPO/POS |
$162.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$171.95
|
| Rate for Payer: Three Rivers Provider Network All |
$135.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$168.33
|
| Rate for Payer: Zelis Auto |
$72.40
|
| Rate for Payer: Zelis Worker's Compensation |
$49.41
|
|
|
REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 99454
|
| Hospital Charge Code |
9600009
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.10 |
| Max. Negotiated Rate |
$171.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$108.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$35.41
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cigna Commercial |
$153.85
|
| Rate for Payer: First Health Commercial |
$162.90
|
| Rate for Payer: First Health Workers Compensation |
$69.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$162.90
|
| Rate for Payer: GEHA Commercial |
$144.80
|
| Rate for Payer: GEHA Medicare |
$35.41
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$162.90
|
| Rate for Payer: Humana ChoiceCare |
$38.95
|
| Rate for Payer: Humana Medicare Advantage |
$35.41
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$59.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$35.41
|
| Rate for Payer: Multiplan All |
$164.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$60.20
|
| Rate for Payer: OMNI Networks Commercial |
$126.70
|
| Rate for Payer: One Health Plan PPO/POS |
$162.90
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$35.41
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$171.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$70.82
|
| Rate for Payer: Three Rivers Provider Network All |
$135.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$34.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$45.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.41
|
| Rate for Payer: United Payors & United Providers UP&UP |
$168.33
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$35.41
|
| Rate for Payer: Zelis Auto |
$72.40
|
| Rate for Payer: Zelis Medicare |
$30.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$42.49
|
| Rate for Payer: Zelis Worker's Compensation |
$49.41
|
|
|
REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 99454
|
| Hospital Charge Code |
8499221
|
|
Hospital Revenue Code
|
513
|
| Min. Negotiated Rate |
$49.41 |
| Max. Negotiated Rate |
$171.95 |
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cigna Commercial |
$153.85
|
| Rate for Payer: First Health Commercial |
$162.90
|
| Rate for Payer: First Health Workers Compensation |
$69.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$162.90
|
| Rate for Payer: GEHA Commercial |
$126.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$162.90
|
| Rate for Payer: Multiplan All |
$164.71
|
| Rate for Payer: OMNI Networks Commercial |
$126.70
|
| Rate for Payer: One Health Plan PPO/POS |
$162.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$171.95
|
| Rate for Payer: Three Rivers Provider Network All |
$135.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$168.33
|
| Rate for Payer: Zelis Auto |
$72.40
|
| Rate for Payer: Zelis Worker's Compensation |
$49.41
|
|
|
REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 99454
|
| Hospital Charge Code |
7999249
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$30.10 |
| Max. Negotiated Rate |
$171.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$108.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$35.41
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cigna Commercial |
$153.85
|
| Rate for Payer: First Health Commercial |
$162.90
|
| Rate for Payer: First Health Workers Compensation |
$69.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$162.90
|
| Rate for Payer: GEHA Commercial |
$144.80
|
| Rate for Payer: GEHA Medicare |
$35.41
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$162.90
|
| Rate for Payer: Humana ChoiceCare |
$38.95
|
| Rate for Payer: Humana Medicare Advantage |
$35.41
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$59.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$35.41
|
| Rate for Payer: Multiplan All |
$164.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$60.20
|
| Rate for Payer: OMNI Networks Commercial |
$126.70
|
| Rate for Payer: One Health Plan PPO/POS |
$162.90
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$35.41
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$171.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$70.82
|
| Rate for Payer: Three Rivers Provider Network All |
$135.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$34.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$45.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.41
|
| Rate for Payer: United Payors & United Providers UP&UP |
$168.33
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$35.41
|
| Rate for Payer: Zelis Auto |
$72.40
|
| Rate for Payer: Zelis Medicare |
$30.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$42.49
|
| Rate for Payer: Zelis Worker's Compensation |
$49.41
|
|
|
REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 99454
|
| Hospital Charge Code |
8300071
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$49.41 |
| Max. Negotiated Rate |
$171.95 |
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cigna Commercial |
$153.85
|
| Rate for Payer: First Health Commercial |
$162.90
|
| Rate for Payer: First Health Workers Compensation |
$69.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$162.90
|
| Rate for Payer: GEHA Commercial |
$126.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$162.90
|
| Rate for Payer: Multiplan All |
$164.71
|
| Rate for Payer: OMNI Networks Commercial |
$126.70
|
| Rate for Payer: One Health Plan PPO/POS |
$162.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$171.95
|
| Rate for Payer: Three Rivers Provider Network All |
$135.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$168.33
|
| Rate for Payer: Zelis Auto |
$72.40
|
| Rate for Payer: Zelis Worker's Compensation |
$49.41
|
|
|
REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 99454
|
| Hospital Charge Code |
21700038
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.41 |
| Max. Negotiated Rate |
$171.95 |
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cigna Commercial |
$153.85
|
| Rate for Payer: First Health Commercial |
$162.90
|
| Rate for Payer: First Health Workers Compensation |
$69.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$162.90
|
| Rate for Payer: GEHA Commercial |
$126.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$162.90
|
| Rate for Payer: Multiplan All |
$164.71
|
| Rate for Payer: OMNI Networks Commercial |
$126.70
|
| Rate for Payer: One Health Plan PPO/POS |
$162.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$171.95
|
| Rate for Payer: Three Rivers Provider Network All |
$135.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$168.33
|
| Rate for Payer: Zelis Auto |
$72.40
|
| Rate for Payer: Zelis Worker's Compensation |
$49.41
|
|
|
REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
CPT 99454
|
| Hospital Charge Code |
1999221
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$30.10 |
| Max. Negotiated Rate |
$184.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$116.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$35.41
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cigna Commercial |
$164.90
|
| Rate for Payer: First Health Commercial |
$174.60
|
| Rate for Payer: First Health Workers Compensation |
$74.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$174.60
|
| Rate for Payer: GEHA Commercial |
$155.20
|
| Rate for Payer: GEHA Medicare |
$35.41
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$174.60
|
| Rate for Payer: Humana ChoiceCare |
$38.95
|
| Rate for Payer: Humana Medicare Advantage |
$35.41
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$59.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$35.41
|
| Rate for Payer: Multiplan All |
$176.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$60.20
|
| Rate for Payer: OMNI Networks Commercial |
$135.80
|
| Rate for Payer: One Health Plan PPO/POS |
$174.60
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$35.41
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$184.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$70.82
|
| Rate for Payer: Three Rivers Provider Network All |
$145.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$34.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$48.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.41
|
| Rate for Payer: United Payors & United Providers UP&UP |
$180.42
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$35.41
|
| Rate for Payer: Zelis Auto |
$77.60
|
| Rate for Payer: Zelis Medicare |
$30.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$42.49
|
| Rate for Payer: Zelis Worker's Compensation |
$52.96
|
|
|
REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 99454
|
| Hospital Charge Code |
21600018
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$49.41 |
| Max. Negotiated Rate |
$171.95 |
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cigna Commercial |
$153.85
|
| Rate for Payer: First Health Commercial |
$162.90
|
| Rate for Payer: First Health Workers Compensation |
$69.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$162.90
|
| Rate for Payer: GEHA Commercial |
$126.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$162.90
|
| Rate for Payer: Multiplan All |
$164.71
|
| Rate for Payer: OMNI Networks Commercial |
$126.70
|
| Rate for Payer: One Health Plan PPO/POS |
$162.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$171.95
|
| Rate for Payer: Three Rivers Provider Network All |
$135.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$168.33
|
| Rate for Payer: Zelis Auto |
$72.40
|
| Rate for Payer: Zelis Worker's Compensation |
$49.41
|
|
|
REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 99454
|
| Hospital Charge Code |
21500018
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.41 |
| Max. Negotiated Rate |
$171.95 |
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cigna Commercial |
$153.85
|
| Rate for Payer: First Health Commercial |
$162.90
|
| Rate for Payer: First Health Workers Compensation |
$69.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$162.90
|
| Rate for Payer: GEHA Commercial |
$126.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$162.90
|
| Rate for Payer: Multiplan All |
$164.71
|
| Rate for Payer: OMNI Networks Commercial |
$126.70
|
| Rate for Payer: One Health Plan PPO/POS |
$162.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$171.95
|
| Rate for Payer: Three Rivers Provider Network All |
$135.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$168.33
|
| Rate for Payer: Zelis Auto |
$72.40
|
| Rate for Payer: Zelis Worker's Compensation |
$49.41
|
|
|
REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 99454
|
| Hospital Charge Code |
25500018
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.41 |
| Max. Negotiated Rate |
$171.95 |
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cigna Commercial |
$153.85
|
| Rate for Payer: First Health Commercial |
$162.90
|
| Rate for Payer: First Health Workers Compensation |
$69.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$162.90
|
| Rate for Payer: GEHA Commercial |
$126.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$162.90
|
| Rate for Payer: Multiplan All |
$164.71
|
| Rate for Payer: OMNI Networks Commercial |
$126.70
|
| Rate for Payer: One Health Plan PPO/POS |
$162.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$171.95
|
| Rate for Payer: Three Rivers Provider Network All |
$135.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$168.33
|
| Rate for Payer: Zelis Auto |
$72.40
|
| Rate for Payer: Zelis Worker's Compensation |
$49.41
|
|
