|
REM MNTR PHYSIOL PARAM 1ST SET UP PT EDU
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 99453
|
| Hospital Charge Code |
8300070
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$15.02 |
| Max. Negotiated Rate |
$52.25 |
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$46.75
|
| Rate for Payer: First Health Commercial |
$49.50
|
| Rate for Payer: First Health Workers Compensation |
$21.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$49.50
|
| Rate for Payer: GEHA Commercial |
$38.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$49.50
|
| Rate for Payer: Multiplan All |
$50.05
|
| Rate for Payer: OMNI Networks Commercial |
$38.50
|
| Rate for Payer: One Health Plan PPO/POS |
$49.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$52.25
|
| Rate for Payer: Three Rivers Provider Network All |
$41.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$51.15
|
| Rate for Payer: Zelis Auto |
$22.00
|
| Rate for Payer: Zelis Worker's Compensation |
$15.02
|
|
|
REM MNTR PHYSIOL PARAM 1ST SET UP PT EDU
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 99453
|
| Hospital Charge Code |
9200029
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$13.75 |
| Max. Negotiated Rate |
$249.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$33.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$124.87
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$46.75
|
| Rate for Payer: First Health Commercial |
$49.50
|
| Rate for Payer: First Health Workers Compensation |
$21.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$49.50
|
| Rate for Payer: GEHA Commercial |
$44.00
|
| Rate for Payer: GEHA Medicare |
$124.87
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$49.50
|
| Rate for Payer: Humana ChoiceCare |
$137.36
|
| Rate for Payer: Humana Medicare Advantage |
$124.87
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$209.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$124.87
|
| Rate for Payer: Multiplan All |
$50.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$212.28
|
| Rate for Payer: OMNI Networks Commercial |
$38.50
|
| Rate for Payer: One Health Plan PPO/POS |
$49.50
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$124.87
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$52.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$249.74
|
| Rate for Payer: Three Rivers Provider Network All |
$41.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$122.37
|
| Rate for Payer: United Healthcare Managed Medicaid |
$13.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$124.87
|
| Rate for Payer: United Payors & United Providers UP&UP |
$51.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$124.87
|
| Rate for Payer: Zelis Auto |
$22.00
|
| Rate for Payer: Zelis Medicare |
$106.14
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$149.84
|
| Rate for Payer: Zelis Worker's Compensation |
$15.02
|
|
|
REM MNTR PHYSIOL PARAM 1ST SET UP PT EDU
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 99453
|
| Hospital Charge Code |
8700007
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.02 |
| Max. Negotiated Rate |
$52.25 |
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$46.75
|
| Rate for Payer: First Health Commercial |
$49.50
|
| Rate for Payer: First Health Workers Compensation |
$21.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$49.50
|
| Rate for Payer: GEHA Commercial |
$38.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$49.50
|
| Rate for Payer: Multiplan All |
$50.05
|
| Rate for Payer: OMNI Networks Commercial |
$38.50
|
| Rate for Payer: One Health Plan PPO/POS |
$49.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$52.25
|
| Rate for Payer: Three Rivers Provider Network All |
$41.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$51.15
|
| Rate for Payer: Zelis Auto |
$22.00
|
| Rate for Payer: Zelis Worker's Compensation |
$15.02
|
|
|
REM MNTR PHYSIOL PARAM 1ST SET UP PT EDU
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 99453
|
| Hospital Charge Code |
21500017
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.02 |
| Max. Negotiated Rate |
$52.25 |
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$46.75
|
| Rate for Payer: First Health Commercial |
$49.50
|
| Rate for Payer: First Health Workers Compensation |
$21.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$49.50
|
| Rate for Payer: GEHA Commercial |
$38.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$49.50
|
| Rate for Payer: Multiplan All |
$50.05
|
| Rate for Payer: OMNI Networks Commercial |
$38.50
|
| Rate for Payer: One Health Plan PPO/POS |
$49.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$52.25
|
| Rate for Payer: Three Rivers Provider Network All |
$41.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$51.15
|
| Rate for Payer: Zelis Auto |
$22.00
|
| Rate for Payer: Zelis Worker's Compensation |
$15.02
|
|
|
REM MNTR PHYSIOL PARAM 1ST SET UP PT EDU
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 99453
|
| Hospital Charge Code |
21700037
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$13.75 |
| Max. Negotiated Rate |
$249.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$33.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$124.87
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$46.75
|
| Rate for Payer: First Health Commercial |
$49.50
|
| Rate for Payer: First Health Workers Compensation |
$21.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$49.50
|
| Rate for Payer: GEHA Commercial |
$44.00
|
| Rate for Payer: GEHA Medicare |
$124.87
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$49.50
|
| Rate for Payer: Humana ChoiceCare |
$137.36
|
| Rate for Payer: Humana Medicare Advantage |
$124.87
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$209.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$124.87
|
| Rate for Payer: Multiplan All |
$50.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$212.28
|
| Rate for Payer: OMNI Networks Commercial |
$38.50
|
| Rate for Payer: One Health Plan PPO/POS |
$49.50
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$124.87
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$52.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$249.74
|
| Rate for Payer: Three Rivers Provider Network All |
$41.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$122.37
|
| Rate for Payer: United Healthcare Managed Medicaid |
$13.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$124.87
|
| Rate for Payer: United Payors & United Providers UP&UP |
$51.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$124.87
|
| Rate for Payer: Zelis Auto |
$22.00
|
| Rate for Payer: Zelis Medicare |
$106.14
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$149.84
|
| Rate for Payer: Zelis Worker's Compensation |
$15.02
|
|
|
REM MNTR PHYSIOL PARAM 1ST SET UP PT EDU
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 99453
|
| Hospital Charge Code |
21600017
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$13.75 |
| Max. Negotiated Rate |
$249.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$33.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$124.87
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$46.75
|
| Rate for Payer: First Health Commercial |
$49.50
|
| Rate for Payer: First Health Workers Compensation |
$21.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$49.50
|
| Rate for Payer: GEHA Commercial |
$44.00
|
| Rate for Payer: GEHA Medicare |
$124.87
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$49.50
|
| Rate for Payer: Humana ChoiceCare |
$137.36
|
| Rate for Payer: Humana Medicare Advantage |
$124.87
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$209.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$124.87
|
| Rate for Payer: Multiplan All |
$50.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$212.28
|
| Rate for Payer: OMNI Networks Commercial |
$38.50
|
| Rate for Payer: One Health Plan PPO/POS |
$49.50
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$124.87
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$52.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$249.74
|
| Rate for Payer: Three Rivers Provider Network All |
$41.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$122.37
|
| Rate for Payer: United Healthcare Managed Medicaid |
$13.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$124.87
|
| Rate for Payer: United Payors & United Providers UP&UP |
$51.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$124.87
|
| Rate for Payer: Zelis Auto |
$22.00
|
| Rate for Payer: Zelis Medicare |
$106.14
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$149.84
|
| Rate for Payer: Zelis Worker's Compensation |
$15.02
|
|
|
REM MNTR PHYSIOL PARAM 1ST SET UP PT EDU
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 99453
|
| Hospital Charge Code |
9400096
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$13.75 |
| Max. Negotiated Rate |
$249.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$33.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$124.87
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$46.75
|
| Rate for Payer: First Health Commercial |
$49.50
|
| Rate for Payer: First Health Workers Compensation |
$21.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$49.50
|
| Rate for Payer: GEHA Commercial |
$44.00
|
| Rate for Payer: GEHA Medicare |
$124.87
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$49.50
|
| Rate for Payer: Humana ChoiceCare |
$137.36
|
| Rate for Payer: Humana Medicare Advantage |
$124.87
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$209.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$124.87
|
| Rate for Payer: Multiplan All |
$50.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$212.28
|
| Rate for Payer: OMNI Networks Commercial |
$38.50
|
| Rate for Payer: One Health Plan PPO/POS |
$49.50
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$124.87
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$52.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$249.74
|
| Rate for Payer: Three Rivers Provider Network All |
$41.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$122.37
|
| Rate for Payer: United Healthcare Managed Medicaid |
$13.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$124.87
|
| Rate for Payer: United Payors & United Providers UP&UP |
$51.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$124.87
|
| Rate for Payer: Zelis Auto |
$22.00
|
| Rate for Payer: Zelis Medicare |
$106.14
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$149.84
|
| Rate for Payer: Zelis Worker's Compensation |
$15.02
|
|
|
REM MNTR PHYSIOL PARAM 1ST SET UP PT EDU
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
CPT 99453
|
| Hospital Charge Code |
11099218
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.38 |
| Max. Negotiated Rate |
$52.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$16.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$16.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$18.09
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$33.00
|
| Rate for Payer: Cimarron Advantage Cimarron Advantage PPO |
$25.33
|
| Rate for Payer: First Health Workers Compensation |
$33.13
|
| Rate for Payer: GEHA Commercial |
$18.09
|
| Rate for Payer: GEHA Medicare |
$18.09
|
| Rate for Payer: Health Net Federal Services Government |
$18.09
|
| Rate for Payer: HealthSmart Commercial |
$25.33
|
| Rate for Payer: HealthSmart Worker's Compensation |
$31.79
|
| Rate for Payer: Humana ChoiceCare |
$19.90
|
| Rate for Payer: Humana Medicare Advantage |
$18.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$25.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$18.09
|
| Rate for Payer: Multiplan All |
$41.25
|
| Rate for Payer: National Preferred Provider Network Commercial |
$52.25
|
| Rate for Payer: National Preferred Provider Network Worker's Compensation |
$33.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$18.99
|
| Rate for Payer: OMNI Networks Commercial |
$38.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$22.46
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$39.26
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.09
|
| Rate for Payer: Zelis Medicare |
$15.38
|
| Rate for Payer: Zelis Worker's Compensation |
$23.42
|
|
|
REM MNTR WRLS P-ART PRS SNR
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT 93264
|
| Hospital Charge Code |
8699250
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$106.40 |
| Rate for Payer: Humana Medicare Advantage |
$36.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$60.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$36.13
|
| Rate for Payer: Multiplan All |
$101.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$61.42
|
| Rate for Payer: OMNI Networks Commercial |
$78.40
|
| Rate for Payer: One Health Plan PPO/POS |
$100.80
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$36.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$106.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$72.26
|
| Rate for Payer: Three Rivers Provider Network All |
$84.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$35.41
|
| Rate for Payer: United Healthcare Managed Medicaid |
$28.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$104.16
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$36.13
|
| Rate for Payer: Zelis Auto |
$44.80
|
| Rate for Payer: Zelis Medicare |
$30.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$43.36
|
| Rate for Payer: Zelis Worker's Compensation |
$30.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$67.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$36.13
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cigna Commercial |
$95.20
|
| Rate for Payer: First Health Commercial |
$100.80
|
| Rate for Payer: First Health Workers Compensation |
$43.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$100.80
|
| Rate for Payer: GEHA Commercial |
$89.60
|
| Rate for Payer: GEHA Medicare |
$36.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$100.80
|
| Rate for Payer: Humana ChoiceCare |
$39.74
|
|
|
REM MNTR WRLS P-ART PRS SNR
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT 93264
|
| Hospital Charge Code |
9000025
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$106.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$67.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$36.13
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cigna Commercial |
$95.20
|
| Rate for Payer: First Health Commercial |
$100.80
|
| Rate for Payer: First Health Workers Compensation |
$43.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$100.80
|
| Rate for Payer: GEHA Commercial |
$89.60
|
| Rate for Payer: GEHA Medicare |
$36.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$100.80
|
| Rate for Payer: Humana ChoiceCare |
$39.74
|
| Rate for Payer: Humana Medicare Advantage |
$36.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$60.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$36.13
|
| Rate for Payer: Multiplan All |
$101.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$61.42
|
| Rate for Payer: OMNI Networks Commercial |
$78.40
|
| Rate for Payer: One Health Plan PPO/POS |
$100.80
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$36.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$106.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$72.26
|
| Rate for Payer: Three Rivers Provider Network All |
$84.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$35.41
|
| Rate for Payer: United Healthcare Managed Medicaid |
$28.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$104.16
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$36.13
|
| Rate for Payer: Zelis Auto |
$44.80
|
| Rate for Payer: Zelis Medicare |
$30.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$43.36
|
| Rate for Payer: Zelis Worker's Compensation |
$30.58
|
|
|
REM MNTR WRLS P-ART PRS SNR
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT 93264
|
| Hospital Charge Code |
9000025
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$30.58 |
| Max. Negotiated Rate |
$106.40 |
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cigna Commercial |
$95.20
|
| Rate for Payer: First Health Commercial |
$100.80
|
| Rate for Payer: First Health Workers Compensation |
$43.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$100.80
|
| Rate for Payer: GEHA Commercial |
$78.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$100.80
|
| Rate for Payer: Multiplan All |
$101.92
|
| Rate for Payer: OMNI Networks Commercial |
$78.40
|
| Rate for Payer: One Health Plan PPO/POS |
$100.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$106.40
|
| Rate for Payer: Three Rivers Provider Network All |
$84.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$104.16
|
| Rate for Payer: Zelis Auto |
$44.80
|
| Rate for Payer: Zelis Worker's Compensation |
$30.58
|
|
|
REM MNTR WRLS P-ART PRS SNR
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT 93264
|
| Hospital Charge Code |
8699250
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$30.58 |
| Max. Negotiated Rate |
$106.40 |
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cigna Commercial |
$95.20
|
| Rate for Payer: First Health Commercial |
$100.80
|
| Rate for Payer: First Health Workers Compensation |
$43.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$100.80
|
| Rate for Payer: GEHA Commercial |
$78.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$100.80
|
| Rate for Payer: Multiplan All |
$101.92
|
| Rate for Payer: OMNI Networks Commercial |
$78.40
|
| Rate for Payer: One Health Plan PPO/POS |
$100.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$106.40
|
| Rate for Payer: Three Rivers Provider Network All |
$84.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$104.16
|
| Rate for Payer: Zelis Auto |
$44.80
|
| Rate for Payer: Zelis Worker's Compensation |
$30.58
|
|
|
REMOT IMAGE SUBMIT BY PT
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
CPT G2010
|
| Hospital Charge Code |
7600020
|
|
Hospital Revenue Code
|
511
|
| Min. Negotiated Rate |
$10.37 |
| Max. Negotiated Rate |
$36.10 |
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$32.30
|
| Rate for Payer: First Health Commercial |
$34.20
|
| Rate for Payer: First Health Workers Compensation |
$14.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$34.20
|
| Rate for Payer: GEHA Commercial |
$26.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$34.20
|
| Rate for Payer: Multiplan All |
$34.58
|
| Rate for Payer: OMNI Networks Commercial |
$26.60
|
| Rate for Payer: One Health Plan PPO/POS |
$34.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$36.10
|
| Rate for Payer: Three Rivers Provider Network All |
$28.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$35.34
|
| Rate for Payer: Zelis Auto |
$15.20
|
| Rate for Payer: Zelis Worker's Compensation |
$10.37
|
|
|
REMOT IMAGE SUBMIT BY PT
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT G2010
|
| Hospital Charge Code |
25500020
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.88 |
| Max. Negotiated Rate |
$36.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$17.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$22.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$17.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$13.89
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$32.30
|
| Rate for Payer: First Health Commercial |
$34.20
|
| Rate for Payer: First Health Workers Compensation |
$14.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$34.20
|
| Rate for Payer: GEHA Commercial |
$30.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$34.20
|
| Rate for Payer: Humana ChoiceCare |
$9.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$14.17
|
| Rate for Payer: Multiplan All |
$34.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$22.80
|
| Rate for Payer: OMNI Networks Commercial |
$26.60
|
| Rate for Payer: One Health Plan PPO/POS |
$34.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$16.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$14.17
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$36.10
|
| Rate for Payer: Three Rivers Provider Network All |
$28.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$33.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14.17
|
| Rate for Payer: United Payors & United Providers UP&UP |
$35.34
|
| Rate for Payer: Zelis Auto |
$15.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$19.00
|
| Rate for Payer: Zelis Worker's Compensation |
$10.37
|
|
|
REMOT IMAGE SUBMIT BY PT
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
CPT G2010
|
| Hospital Charge Code |
21600020
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$10.37 |
| Max. Negotiated Rate |
$36.10 |
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$32.30
|
| Rate for Payer: First Health Commercial |
$34.20
|
| Rate for Payer: First Health Workers Compensation |
$14.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$34.20
|
| Rate for Payer: GEHA Commercial |
$26.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$34.20
|
| Rate for Payer: Multiplan All |
$34.58
|
| Rate for Payer: OMNI Networks Commercial |
$26.60
|
| Rate for Payer: One Health Plan PPO/POS |
$34.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$36.10
|
| Rate for Payer: Three Rivers Provider Network All |
$28.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$35.34
|
| Rate for Payer: Zelis Auto |
$15.20
|
| Rate for Payer: Zelis Worker's Compensation |
$10.37
|
|
|
REMOT IMAGE SUBMIT BY PT
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT G2010
|
| Hospital Charge Code |
8500015
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$9.88 |
| Max. Negotiated Rate |
$36.10 |
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$32.30
|
| Rate for Payer: First Health Commercial |
$34.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$17.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$22.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$17.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$13.89
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: First Health Workers Compensation |
$14.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$34.20
|
| Rate for Payer: GEHA Commercial |
$30.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$34.20
|
| Rate for Payer: Humana ChoiceCare |
$9.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$14.17
|
| Rate for Payer: Multiplan All |
$34.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$22.80
|
| Rate for Payer: OMNI Networks Commercial |
$26.60
|
| Rate for Payer: One Health Plan PPO/POS |
$34.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$16.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$14.17
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$36.10
|
| Rate for Payer: Three Rivers Provider Network All |
$28.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$33.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14.17
|
| Rate for Payer: United Payors & United Providers UP&UP |
$35.34
|
| Rate for Payer: Zelis Auto |
$15.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$19.00
|
| Rate for Payer: Zelis Worker's Compensation |
$10.37
|
|
|
REMOT IMAGE SUBMIT BY PT
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
CPT G2010
|
| Hospital Charge Code |
7599221
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.37 |
| Max. Negotiated Rate |
$36.10 |
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$32.30
|
| Rate for Payer: First Health Commercial |
$34.20
|
| Rate for Payer: First Health Workers Compensation |
$14.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$34.20
|
| Rate for Payer: GEHA Commercial |
$26.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$34.20
|
| Rate for Payer: Multiplan All |
$34.58
|
| Rate for Payer: OMNI Networks Commercial |
$26.60
|
| Rate for Payer: One Health Plan PPO/POS |
$34.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$36.10
|
| Rate for Payer: Three Rivers Provider Network All |
$28.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$35.34
|
| Rate for Payer: Zelis Auto |
$15.20
|
| Rate for Payer: Zelis Worker's Compensation |
$10.37
|
|
|
REMOT IMAGE SUBMIT BY PT
|
Professional
|
Both
|
$28.00
|
|
|
Service Code
|
CPT G2010
|
| Hospital Charge Code |
12099221
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4.15 |
| Max. Negotiated Rate |
$26.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$6.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$11.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$6.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8.55
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna Commercial |
$16.80
|
| Rate for Payer: Cimarron Advantage Cimarron Advantage PPO |
$11.97
|
| Rate for Payer: GEHA Commercial |
$8.55
|
| Rate for Payer: GEHA Medicare |
$8.55
|
| Rate for Payer: Health Net Federal Services Government |
$8.55
|
| Rate for Payer: Humana ChoiceCare |
$9.40
|
| Rate for Payer: Humana Medicare Advantage |
$8.55
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8.55
|
| Rate for Payer: Multiplan All |
$21.00
|
| Rate for Payer: National Preferred Provider Network Commercial |
$26.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.98
|
| Rate for Payer: OMNI Networks Commercial |
$19.60
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4.15
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9.11
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$18.55
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.55
|
| Rate for Payer: Zelis Medicare |
$7.27
|
|
|
REMOT IMAGE SUBMIT BY PT
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT G2010
|
| Hospital Charge Code |
8600017
|
|
Hospital Revenue Code
|
985
|
| Min. Negotiated Rate |
$9.88 |
| Max. Negotiated Rate |
$36.10 |
| Rate for Payer: Multiplan All |
$34.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$22.80
|
| Rate for Payer: OMNI Networks Commercial |
$26.60
|
| Rate for Payer: One Health Plan PPO/POS |
$34.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$16.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$14.17
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$36.10
|
| Rate for Payer: Three Rivers Provider Network All |
$28.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$33.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14.17
|
| Rate for Payer: United Payors & United Providers UP&UP |
$35.34
|
| Rate for Payer: Zelis Auto |
$15.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$19.00
|
| Rate for Payer: Zelis Worker's Compensation |
$10.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$17.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$22.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$17.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$13.89
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$32.30
|
| Rate for Payer: First Health Commercial |
$34.20
|
| Rate for Payer: First Health Workers Compensation |
$14.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$34.20
|
| Rate for Payer: GEHA Commercial |
$30.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$34.20
|
| Rate for Payer: Humana ChoiceCare |
$9.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$14.17
|
|
|
REMOT IMAGE SUBMIT BY PT
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
CPT G2010
|
| Hospital Charge Code |
21500020
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$10.37 |
| Max. Negotiated Rate |
$36.10 |
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$32.30
|
| Rate for Payer: First Health Commercial |
$34.20
|
| Rate for Payer: First Health Workers Compensation |
$14.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$34.20
|
| Rate for Payer: GEHA Commercial |
$26.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$34.20
|
| Rate for Payer: Multiplan All |
$34.58
|
| Rate for Payer: OMNI Networks Commercial |
$26.60
|
| Rate for Payer: One Health Plan PPO/POS |
$34.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$36.10
|
| Rate for Payer: Three Rivers Provider Network All |
$28.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$35.34
|
| Rate for Payer: Zelis Auto |
$15.20
|
| Rate for Payer: Zelis Worker's Compensation |
$10.37
|
|
|
REMOT IMAGE SUBMIT BY PT
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
CPT G2010
|
| Hospital Charge Code |
8700010
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.37 |
| Max. Negotiated Rate |
$36.10 |
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$32.30
|
| Rate for Payer: First Health Commercial |
$34.20
|
| Rate for Payer: First Health Workers Compensation |
$14.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$34.20
|
| Rate for Payer: GEHA Commercial |
$26.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$34.20
|
| Rate for Payer: Multiplan All |
$34.58
|
| Rate for Payer: OMNI Networks Commercial |
$26.60
|
| Rate for Payer: One Health Plan PPO/POS |
$34.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$36.10
|
| Rate for Payer: Three Rivers Provider Network All |
$28.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$35.34
|
| Rate for Payer: Zelis Auto |
$15.20
|
| Rate for Payer: Zelis Worker's Compensation |
$10.37
|
|
|
REMOT IMAGE SUBMIT BY PT
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT G2010
|
| Hospital Charge Code |
9799221
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.88 |
| Max. Negotiated Rate |
$36.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$17.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$22.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$17.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$13.89
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$32.30
|
| Rate for Payer: First Health Commercial |
$34.20
|
| Rate for Payer: First Health Workers Compensation |
$14.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$34.20
|
| Rate for Payer: GEHA Commercial |
$30.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$34.20
|
| Rate for Payer: Humana ChoiceCare |
$9.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$14.17
|
| Rate for Payer: Multiplan All |
$34.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$22.80
|
| Rate for Payer: OMNI Networks Commercial |
$26.60
|
| Rate for Payer: One Health Plan PPO/POS |
$34.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$16.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$14.17
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$36.10
|
| Rate for Payer: Three Rivers Provider Network All |
$28.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$33.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14.17
|
| Rate for Payer: United Payors & United Providers UP&UP |
$35.34
|
| Rate for Payer: Zelis Auto |
$15.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$19.00
|
| Rate for Payer: Zelis Worker's Compensation |
$10.37
|
|
|
REMOT IMAGE SUBMIT BY PT
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
CPT G2010
|
| Hospital Charge Code |
21700040
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.37 |
| Max. Negotiated Rate |
$36.10 |
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$32.30
|
| Rate for Payer: First Health Commercial |
$34.20
|
| Rate for Payer: First Health Workers Compensation |
$14.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$34.20
|
| Rate for Payer: GEHA Commercial |
$26.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$34.20
|
| Rate for Payer: Multiplan All |
$34.58
|
| Rate for Payer: OMNI Networks Commercial |
$26.60
|
| Rate for Payer: One Health Plan PPO/POS |
$34.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$36.10
|
| Rate for Payer: Three Rivers Provider Network All |
$28.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$35.34
|
| Rate for Payer: Zelis Auto |
$15.20
|
| Rate for Payer: Zelis Worker's Compensation |
$10.37
|
|
|
REMOT IMAGE SUBMIT BY PT
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT G2010
|
| Hospital Charge Code |
7599221
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.88 |
| Max. Negotiated Rate |
$36.10 |
| Rate for Payer: One Health Plan PPO/POS |
$34.20
|
| Rate for Payer: OMNI Networks Commercial |
$26.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$17.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$22.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$17.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$13.89
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$32.30
|
| Rate for Payer: First Health Commercial |
$34.20
|
| Rate for Payer: First Health Workers Compensation |
$14.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$34.20
|
| Rate for Payer: GEHA Commercial |
$30.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$34.20
|
| Rate for Payer: Humana ChoiceCare |
$9.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$14.17
|
| Rate for Payer: Multiplan All |
$34.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$22.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$16.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$14.17
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$36.10
|
| Rate for Payer: Three Rivers Provider Network All |
$28.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$33.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14.17
|
| Rate for Payer: United Payors & United Providers UP&UP |
$35.34
|
| Rate for Payer: Zelis Auto |
$15.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$19.00
|
| Rate for Payer: Zelis Worker's Compensation |
$10.37
|
|
|
REMOT IMAGE SUBMIT BY PT
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
CPT G2010
|
| Hospital Charge Code |
20399224
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$10.37 |
| Max. Negotiated Rate |
$36.10 |
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$32.30
|
| Rate for Payer: First Health Commercial |
$34.20
|
| Rate for Payer: First Health Workers Compensation |
$14.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$34.20
|
| Rate for Payer: GEHA Commercial |
$26.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$34.20
|
| Rate for Payer: Multiplan All |
$34.58
|
| Rate for Payer: OMNI Networks Commercial |
$26.60
|
| Rate for Payer: One Health Plan PPO/POS |
$34.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$36.10
|
| Rate for Payer: Three Rivers Provider Network All |
$28.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$35.34
|
| Rate for Payer: Zelis Auto |
$15.20
|
| Rate for Payer: Zelis Worker's Compensation |
$10.37
|
|
