|
OTA US-15 MIN
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
CPT 97035 GO,CO
|
| Hospital Charge Code |
4597035
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$18.68 |
| Max. Negotiated Rate |
$121.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$29.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$76.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$29.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$23.54
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cigna Commercial |
$108.80
|
| Rate for Payer: First Health Commercial |
$115.20
|
| Rate for Payer: First Health Workers Compensation |
$26.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$115.20
|
| Rate for Payer: GEHA Commercial |
$102.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$115.20
|
| Rate for Payer: Humana ChoiceCare |
$33.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24.02
|
| Rate for Payer: Multiplan All |
$116.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$76.80
|
| Rate for Payer: OMNI Networks Commercial |
$89.60
|
| Rate for Payer: One Health Plan PPO/POS |
$115.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$27.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$24.02
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$121.60
|
| Rate for Payer: Three Rivers Provider Network All |
$96.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$112.64
|
| Rate for Payer: United Healthcare Commercial |
$108.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.02
|
| Rate for Payer: United Payors & United Providers UP&UP |
$119.04
|
| Rate for Payer: Zelis Auto |
$51.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$64.00
|
| Rate for Payer: Zelis Worker's Compensation |
$18.68
|
|
|
OTA WHEELCHAIR MNGMT TRA
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 97542 GO,CO
|
| Hospital Charge Code |
4597542
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$32.45 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$40.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$40.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$32.45
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cigna Commercial |
$129.20
|
| Rate for Payer: First Health Commercial |
$136.80
|
| Rate for Payer: First Health Workers Compensation |
$60.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$136.80
|
| Rate for Payer: GEHA Commercial |
$121.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$136.80
|
| Rate for Payer: Humana ChoiceCare |
$39.52
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$33.11
|
| Rate for Payer: Multiplan All |
$138.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$91.20
|
| Rate for Payer: OMNI Networks Commercial |
$106.40
|
| Rate for Payer: One Health Plan PPO/POS |
$136.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$38.23
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$33.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$144.40
|
| Rate for Payer: Three Rivers Provider Network All |
$114.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$133.76
|
| Rate for Payer: United Healthcare Commercial |
$129.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$33.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$141.36
|
| Rate for Payer: Zelis Auto |
$60.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$76.00
|
| Rate for Payer: Zelis Worker's Compensation |
$42.49
|
|
|
OTA WHEELCHAIR MNGMT TRA
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 97542 GO,CO
|
| Hospital Charge Code |
4597542
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$41.50 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cigna Commercial |
$129.20
|
| Rate for Payer: First Health Commercial |
$136.80
|
| Rate for Payer: First Health Workers Compensation |
$58.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$136.80
|
| Rate for Payer: GEHA Commercial |
$106.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$136.80
|
| Rate for Payer: Multiplan All |
$138.32
|
| Rate for Payer: OMNI Networks Commercial |
$106.40
|
| Rate for Payer: One Health Plan PPO/POS |
$136.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$144.40
|
| Rate for Payer: Three Rivers Provider Network All |
$114.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$141.36
|
| Rate for Payer: Zelis Auto |
$60.80
|
| Rate for Payer: Zelis Worker's Compensation |
$41.50
|
|
|
OTA WHIRLPOOL THERAPY
|
Facility
|
OP
|
$219.00
|
|
|
Service Code
|
CPT 97022 GO,CO
|
| Hospital Charge Code |
4597810
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$22.41 |
| Max. Negotiated Rate |
$208.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$35.46
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$131.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$35.46
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$28.09
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cigna Commercial |
$186.15
|
| Rate for Payer: First Health Commercial |
$197.10
|
| Rate for Payer: First Health Workers Compensation |
$31.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$197.10
|
| Rate for Payer: GEHA Commercial |
$175.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$197.10
|
| Rate for Payer: Humana ChoiceCare |
$56.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$28.66
|
| Rate for Payer: Multiplan All |
$199.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$131.40
|
| Rate for Payer: OMNI Networks Commercial |
$153.30
|
| Rate for Payer: One Health Plan PPO/POS |
$197.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$33.10
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$28.66
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$208.05
|
| Rate for Payer: Three Rivers Provider Network All |
$164.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$192.72
|
| Rate for Payer: United Healthcare Commercial |
$186.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$28.66
|
| Rate for Payer: United Payors & United Providers UP&UP |
$203.67
|
| Rate for Payer: Zelis Auto |
$87.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$109.50
|
| Rate for Payer: Zelis Worker's Compensation |
$22.41
|
|
|
OTA WHIRLPOOL THERAPY
|
Facility
|
IP
|
$219.00
|
|
|
Service Code
|
CPT 97022 GO,CO
|
| Hospital Charge Code |
4597810
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$59.79 |
| Max. Negotiated Rate |
$208.05 |
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cigna Commercial |
$186.15
|
| Rate for Payer: First Health Commercial |
$197.10
|
| Rate for Payer: First Health Workers Compensation |
$84.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$197.10
|
| Rate for Payer: GEHA Commercial |
$153.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$197.10
|
| Rate for Payer: Multiplan All |
$199.29
|
| Rate for Payer: OMNI Networks Commercial |
$153.30
|
| Rate for Payer: One Health Plan PPO/POS |
$197.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$208.05
|
| Rate for Payer: Three Rivers Provider Network All |
$164.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$203.67
|
| Rate for Payer: Zelis Auto |
$87.60
|
| Rate for Payer: Zelis Worker's Compensation |
$59.79
|
|
|
OTA WORK HARDENING INITIAL 2 HOURS
|
Facility
|
IP
|
$761.00
|
|
|
Service Code
|
CPT 97545 GO,CO
|
| Hospital Charge Code |
4597817
|
|
Hospital Revenue Code
|
432
|
| Min. Negotiated Rate |
$207.75 |
| Max. Negotiated Rate |
$722.95 |
| Rate for Payer: Cash Price |
$456.60
|
| Rate for Payer: Cigna Commercial |
$646.85
|
| Rate for Payer: First Health Commercial |
$684.90
|
| Rate for Payer: First Health Workers Compensation |
$293.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$684.90
|
| Rate for Payer: GEHA Commercial |
$532.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$684.90
|
| Rate for Payer: Multiplan All |
$692.51
|
| Rate for Payer: OMNI Networks Commercial |
$532.70
|
| Rate for Payer: One Health Plan PPO/POS |
$684.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$722.95
|
| Rate for Payer: Three Rivers Provider Network All |
$570.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$707.73
|
| Rate for Payer: Zelis Auto |
$304.40
|
| Rate for Payer: Zelis Worker's Compensation |
$207.75
|
|
|
OTA WORK HARDENING INITIAL 2 HOURS
|
Facility
|
OP
|
$761.00
|
|
|
Service Code
|
CPT 97545 GO,CO
|
| Hospital Charge Code |
4597817
|
|
Hospital Revenue Code
|
432
|
| Min. Negotiated Rate |
$112.53 |
| Max. Negotiated Rate |
$722.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$456.60
|
| Rate for Payer: Cash Price |
$456.60
|
| Rate for Payer: Cash Price |
$456.60
|
| Rate for Payer: Cigna Commercial |
$646.85
|
| Rate for Payer: First Health Commercial |
$684.90
|
| Rate for Payer: First Health Workers Compensation |
$159.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$684.90
|
| Rate for Payer: GEHA Commercial |
$608.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$684.90
|
| Rate for Payer: Humana ChoiceCare |
$197.86
|
| Rate for Payer: Multiplan All |
$692.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$456.60
|
| Rate for Payer: OMNI Networks Commercial |
$532.70
|
| Rate for Payer: One Health Plan PPO/POS |
$684.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$722.95
|
| Rate for Payer: Three Rivers Provider Network All |
$570.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$669.68
|
| Rate for Payer: United Healthcare Commercial |
$646.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$190.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$707.73
|
| Rate for Payer: Zelis Auto |
$304.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$380.50
|
| Rate for Payer: Zelis Worker's Compensation |
$112.53
|
|
|
OT BIOFEEDBACK TRAIN, ANY ME
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 90901
|
| Hospital Charge Code |
4590901
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$28.94 |
| Max. Negotiated Rate |
$100.70 |
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$90.10
|
| Rate for Payer: First Health Commercial |
$95.40
|
| Rate for Payer: First Health Workers Compensation |
$40.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$95.40
|
| Rate for Payer: GEHA Commercial |
$74.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$95.40
|
| Rate for Payer: Multiplan All |
$96.46
|
| Rate for Payer: OMNI Networks Commercial |
$74.20
|
| Rate for Payer: One Health Plan PPO/POS |
$95.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$100.70
|
| Rate for Payer: Three Rivers Provider Network All |
$79.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$98.58
|
| Rate for Payer: Zelis Auto |
$42.40
|
| Rate for Payer: Zelis Worker's Compensation |
$28.94
|
|
|
OT BIOFEEDBACK TRAIN, ANY ME
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
CPT 90901
|
| Hospital Charge Code |
4590901
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$26.50 |
| Max. Negotiated Rate |
$100.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$63.60
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$90.10
|
| Rate for Payer: First Health Commercial |
$95.40
|
| Rate for Payer: First Health Workers Compensation |
$76.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$95.40
|
| Rate for Payer: GEHA Commercial |
$84.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$95.40
|
| Rate for Payer: Humana ChoiceCare |
$27.56
|
| Rate for Payer: Multiplan All |
$96.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$63.60
|
| Rate for Payer: OMNI Networks Commercial |
$74.20
|
| Rate for Payer: One Health Plan PPO/POS |
$95.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$100.70
|
| Rate for Payer: Three Rivers Provider Network All |
$79.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$93.28
|
| Rate for Payer: United Healthcare Commercial |
$90.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$26.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$98.58
|
| Rate for Payer: Zelis Auto |
$42.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$53.00
|
| Rate for Payer: Zelis Worker's Compensation |
$54.16
|
|
|
OT C/O FOR ORTHOTIC/PROSTH USE, ESTABLIS
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
4597762
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$44.23 |
| Max. Negotiated Rate |
$153.90 |
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cigna Commercial |
$137.70
|
| Rate for Payer: First Health Commercial |
$145.80
|
| Rate for Payer: First Health Workers Compensation |
$62.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$145.80
|
| Rate for Payer: GEHA Commercial |
$113.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$145.80
|
| Rate for Payer: Multiplan All |
$147.42
|
| Rate for Payer: OMNI Networks Commercial |
$113.40
|
| Rate for Payer: One Health Plan PPO/POS |
$145.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$153.90
|
| Rate for Payer: Three Rivers Provider Network All |
$121.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$150.66
|
| Rate for Payer: Zelis Auto |
$64.80
|
| Rate for Payer: Zelis Worker's Compensation |
$44.23
|
|
|
OT C/O FOR ORTHOTIC/PROSTH USE, ESTABLIS
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
4597762
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$42.12 |
| Max. Negotiated Rate |
$153.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$108.48
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$97.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$108.48
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$85.94
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cigna Commercial |
$137.70
|
| Rate for Payer: First Health Commercial |
$145.80
|
| Rate for Payer: First Health Workers Compensation |
$97.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$145.80
|
| Rate for Payer: GEHA Commercial |
$129.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$145.80
|
| Rate for Payer: Humana ChoiceCare |
$42.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$87.69
|
| Rate for Payer: Multiplan All |
$147.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$97.20
|
| Rate for Payer: OMNI Networks Commercial |
$113.40
|
| Rate for Payer: One Health Plan PPO/POS |
$145.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$101.25
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$87.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$153.90
|
| Rate for Payer: Three Rivers Provider Network All |
$121.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$142.56
|
| Rate for Payer: United Healthcare Commercial |
$137.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$87.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$150.66
|
| Rate for Payer: Zelis Auto |
$64.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$81.00
|
| Rate for Payer: Zelis Worker's Compensation |
$68.64
|
|
|
OT COGNITIVE SKILLS DEVELOPMENT
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT G0515
|
| Hospital Charge Code |
4500046
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$21.50 |
| Max. Negotiated Rate |
$81.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$51.60
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cigna Commercial |
$73.10
|
| Rate for Payer: First Health Commercial |
$77.40
|
| Rate for Payer: First Health Workers Compensation |
$33.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$77.40
|
| Rate for Payer: GEHA Commercial |
$68.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$77.40
|
| Rate for Payer: Humana ChoiceCare |
$22.36
|
| Rate for Payer: Multiplan All |
$78.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$51.60
|
| Rate for Payer: OMNI Networks Commercial |
$60.20
|
| Rate for Payer: One Health Plan PPO/POS |
$77.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$81.70
|
| Rate for Payer: Three Rivers Provider Network All |
$64.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$75.68
|
| Rate for Payer: United Healthcare Commercial |
$73.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$21.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$79.98
|
| Rate for Payer: Zelis Auto |
$34.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$43.00
|
| Rate for Payer: Zelis Worker's Compensation |
$23.48
|
|
|
OT COGNITIVE SKILLS DEVELOPMENT
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT G0515
|
| Hospital Charge Code |
4500046
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$23.48 |
| Max. Negotiated Rate |
$81.70 |
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cigna Commercial |
$73.10
|
| Rate for Payer: First Health Commercial |
$77.40
|
| Rate for Payer: First Health Workers Compensation |
$33.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$77.40
|
| Rate for Payer: GEHA Commercial |
$60.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$77.40
|
| Rate for Payer: Multiplan All |
$78.26
|
| Rate for Payer: OMNI Networks Commercial |
$60.20
|
| Rate for Payer: One Health Plan PPO/POS |
$77.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$81.70
|
| Rate for Payer: Three Rivers Provider Network All |
$64.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$79.98
|
| Rate for Payer: Zelis Auto |
$34.40
|
| Rate for Payer: Zelis Worker's Compensation |
$23.48
|
|
|
OT COMM/WORK REINTEG
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
CPT 97537
|
| Hospital Charge Code |
4500063
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$39.31 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cigna Commercial |
$122.40
|
| Rate for Payer: First Health Commercial |
$129.60
|
| Rate for Payer: First Health Workers Compensation |
$55.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$129.60
|
| Rate for Payer: GEHA Commercial |
$100.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$129.60
|
| Rate for Payer: Multiplan All |
$131.04
|
| Rate for Payer: OMNI Networks Commercial |
$100.80
|
| Rate for Payer: One Health Plan PPO/POS |
$129.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$136.80
|
| Rate for Payer: Three Rivers Provider Network All |
$108.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$133.92
|
| Rate for Payer: Zelis Auto |
$57.60
|
| Rate for Payer: Zelis Worker's Compensation |
$39.31
|
|
|
OT COMM/WORK REINTEG
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
CPT 97537
|
| Hospital Charge Code |
4500063
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$31.63 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$39.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$86.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$39.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$31.63
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cigna Commercial |
$122.40
|
| Rate for Payer: First Health Commercial |
$129.60
|
| Rate for Payer: First Health Workers Compensation |
$60.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$129.60
|
| Rate for Payer: GEHA Commercial |
$115.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$129.60
|
| Rate for Payer: Humana ChoiceCare |
$37.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$32.28
|
| Rate for Payer: Multiplan All |
$131.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$86.40
|
| Rate for Payer: OMNI Networks Commercial |
$100.80
|
| Rate for Payer: One Health Plan PPO/POS |
$129.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$37.27
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$32.28
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$136.80
|
| Rate for Payer: Three Rivers Provider Network All |
$108.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$126.72
|
| Rate for Payer: United Healthcare Commercial |
$122.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$32.28
|
| Rate for Payer: United Payors & United Providers UP&UP |
$133.92
|
| Rate for Payer: Zelis Auto |
$57.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$72.00
|
| Rate for Payer: Zelis Worker's Compensation |
$42.49
|
|
|
OT CONTRAST BATH THERAPY CONST ATTEND
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
4590179
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$18.68 |
| Max. Negotiated Rate |
$106.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$29.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$67.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$29.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$23.54
|
| Rate for Payer: Cash Price |
$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 |
$26.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$100.80
|
| Rate for Payer: GEHA Commercial |
$89.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$100.80
|
| Rate for Payer: Humana ChoiceCare |
$29.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24.02
|
| Rate for Payer: Multiplan All |
$101.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$67.20
|
| Rate for Payer: OMNI Networks Commercial |
$78.40
|
| Rate for Payer: One Health Plan PPO/POS |
$100.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$27.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$24.02
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$106.40
|
| Rate for Payer: Three Rivers Provider Network All |
$84.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.56
|
| Rate for Payer: United Healthcare Commercial |
$95.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.02
|
| Rate for Payer: United Payors & United Providers UP&UP |
$104.16
|
| Rate for Payer: Zelis Auto |
$44.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$56.00
|
| Rate for Payer: Zelis Worker's Compensation |
$18.68
|
|
|
OT CONTRAST BATH THERAPY CONST ATTEND
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
4590179
|
|
Hospital Revenue Code
|
430
|
| 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
|
|
|
OT DEVELOPMENTAL SCREENING
|
Facility
|
OP
|
$380.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
4596110
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$14.32 |
| Max. Negotiated Rate |
$361.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$18.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$228.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$18.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$14.32
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$323.00
|
| Rate for Payer: First Health Commercial |
$342.00
|
| Rate for Payer: First Health Workers Compensation |
$21.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$342.00
|
| Rate for Payer: GEHA Commercial |
$304.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$342.00
|
| Rate for Payer: Humana ChoiceCare |
$98.80
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$14.61
|
| Rate for Payer: Multiplan All |
$345.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$228.00
|
| Rate for Payer: OMNI Networks Commercial |
$266.00
|
| Rate for Payer: One Health Plan PPO/POS |
$342.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$16.87
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$14.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$361.00
|
| Rate for Payer: Three Rivers Provider Network All |
$285.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$334.40
|
| Rate for Payer: United Healthcare Commercial |
$323.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$353.40
|
| Rate for Payer: Zelis Auto |
$152.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$190.00
|
| Rate for Payer: Zelis Worker's Compensation |
$15.54
|
|
|
OT DEVELOPMENTAL SCREENING
|
Facility
|
IP
|
$380.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
4596110
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$103.74 |
| Max. Negotiated Rate |
$361.00 |
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$323.00
|
| Rate for Payer: First Health Commercial |
$342.00
|
| Rate for Payer: First Health Workers Compensation |
$146.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$342.00
|
| Rate for Payer: GEHA Commercial |
$266.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$342.00
|
| Rate for Payer: Multiplan All |
$345.80
|
| Rate for Payer: OMNI Networks Commercial |
$266.00
|
| Rate for Payer: One Health Plan PPO/POS |
$342.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$361.00
|
| Rate for Payer: Three Rivers Provider Network All |
$285.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$353.40
|
| Rate for Payer: Zelis Auto |
$152.00
|
| Rate for Payer: Zelis Worker's Compensation |
$103.74
|
|
|
OT DIATHERMY EG MICROWAVE
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
CPT 97024
|
| Hospital Charge Code |
4597024
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$9.81 |
| Max. Negotiated Rate |
$126.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$15.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$79.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$15.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$12.13
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$113.05
|
| Rate for Payer: First Health Commercial |
$119.70
|
| Rate for Payer: First Health Workers Compensation |
$13.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$119.70
|
| Rate for Payer: GEHA Commercial |
$106.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$119.70
|
| Rate for Payer: Humana ChoiceCare |
$34.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$12.38
|
| Rate for Payer: Multiplan All |
$121.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$79.80
|
| Rate for Payer: OMNI Networks Commercial |
$93.10
|
| Rate for Payer: One Health Plan PPO/POS |
$119.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$14.29
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$12.38
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$126.35
|
| Rate for Payer: Three Rivers Provider Network All |
$99.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$117.04
|
| Rate for Payer: United Healthcare Commercial |
$113.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$12.38
|
| Rate for Payer: United Payors & United Providers UP&UP |
$123.69
|
| Rate for Payer: Zelis Auto |
$53.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$66.50
|
| Rate for Payer: Zelis Worker's Compensation |
$9.81
|
|
|
OT DIATHERMY EG MICROWAVE
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
CPT 97024
|
| Hospital Charge Code |
4597024
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$36.31 |
| Max. Negotiated Rate |
$126.35 |
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$113.05
|
| Rate for Payer: First Health Commercial |
$119.70
|
| Rate for Payer: First Health Workers Compensation |
$51.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$119.70
|
| Rate for Payer: GEHA Commercial |
$93.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$119.70
|
| Rate for Payer: Multiplan All |
$121.03
|
| Rate for Payer: OMNI Networks Commercial |
$93.10
|
| Rate for Payer: One Health Plan PPO/POS |
$119.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$126.35
|
| Rate for Payer: Three Rivers Provider Network All |
$99.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$123.69
|
| Rate for Payer: Zelis Auto |
$53.20
|
| Rate for Payer: Zelis Worker's Compensation |
$36.31
|
|
|
OT ELEC STIM CONST ATTE
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
4503030
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$19.61 |
| Max. Negotiated Rate |
$157.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$30.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$99.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$30.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$24.29
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cigna Commercial |
$141.10
|
| Rate for Payer: First Health Commercial |
$149.40
|
| Rate for Payer: First Health Workers Compensation |
$27.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$149.40
|
| Rate for Payer: GEHA Commercial |
$132.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$149.40
|
| Rate for Payer: Humana ChoiceCare |
$43.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24.78
|
| Rate for Payer: Multiplan All |
$151.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$99.60
|
| Rate for Payer: OMNI Networks Commercial |
$116.20
|
| Rate for Payer: One Health Plan PPO/POS |
$149.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$28.62
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$24.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$157.70
|
| Rate for Payer: Three Rivers Provider Network All |
$124.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$146.08
|
| Rate for Payer: United Healthcare Commercial |
$141.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$154.38
|
| Rate for Payer: Zelis Auto |
$66.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$83.00
|
| Rate for Payer: Zelis Worker's Compensation |
$19.61
|
|
|
OT ELEC STIM CONST ATTE
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
4503030
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$45.32 |
| Max. Negotiated Rate |
$157.70 |
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cigna Commercial |
$141.10
|
| Rate for Payer: First Health Commercial |
$149.40
|
| Rate for Payer: First Health Workers Compensation |
$64.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$149.40
|
| Rate for Payer: GEHA Commercial |
$116.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$149.40
|
| Rate for Payer: Multiplan All |
$151.06
|
| Rate for Payer: OMNI Networks Commercial |
$116.20
|
| Rate for Payer: One Health Plan PPO/POS |
$149.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$157.70
|
| Rate for Payer: Three Rivers Provider Network All |
$124.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$154.38
|
| Rate for Payer: Zelis Auto |
$66.40
|
| Rate for Payer: Zelis Worker's Compensation |
$45.32
|
|
|
OT EVAL HIGH COMPLEX
|
Facility
|
IP
|
$542.00
|
|
|
Service Code
|
CPT 97167
|
| Hospital Charge Code |
4597167
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$147.97 |
| Max. Negotiated Rate |
$514.90 |
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$460.70
|
| Rate for Payer: First Health Commercial |
$487.80
|
| Rate for Payer: First Health Workers Compensation |
$209.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$487.80
|
| Rate for Payer: GEHA Commercial |
$379.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$487.80
|
| Rate for Payer: Multiplan All |
$493.22
|
| Rate for Payer: OMNI Networks Commercial |
$379.40
|
| Rate for Payer: One Health Plan PPO/POS |
$487.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$514.90
|
| Rate for Payer: Three Rivers Provider Network All |
$406.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$504.06
|
| Rate for Payer: Zelis Auto |
$216.80
|
| Rate for Payer: Zelis Worker's Compensation |
$147.97
|
|
|
OT EVAL HIGH COMPLEX
|
Facility
|
OP
|
$542.00
|
|
|
Service Code
|
CPT 97167
|
| Hospital Charge Code |
4597167
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$135.87 |
| Max. Negotiated Rate |
$514.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$214.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$325.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$214.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$169.99
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$460.70
|
| Rate for Payer: First Health Commercial |
$487.80
|
| Rate for Payer: First Health Workers Compensation |
$192.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$487.80
|
| Rate for Payer: GEHA Commercial |
$433.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$487.80
|
| Rate for Payer: Humana ChoiceCare |
$140.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$173.45
|
| Rate for Payer: Multiplan All |
$493.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$325.20
|
| Rate for Payer: OMNI Networks Commercial |
$379.40
|
| Rate for Payer: One Health Plan PPO/POS |
$487.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$200.27
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$173.45
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$514.90
|
| Rate for Payer: Three Rivers Provider Network All |
$406.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$476.96
|
| Rate for Payer: United Healthcare Commercial |
$460.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$173.45
|
| Rate for Payer: United Payors & United Providers UP&UP |
$504.06
|
| Rate for Payer: Zelis Auto |
$216.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$271.00
|
| Rate for Payer: Zelis Worker's Compensation |
$135.87
|
|
