|
OT EVAL LOW COMPLEXITY/WC EVAL
|
Facility
|
OP
|
$441.00
|
|
|
Service Code
|
CPT 97165
|
| Hospital Charge Code |
4597165
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$114.66 |
| Max. Negotiated Rate |
$418.95 |
| 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 |
$264.60
|
| 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 |
$264.60
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: Cigna Commercial |
$374.85
|
| Rate for Payer: First Health Commercial |
$396.90
|
| Rate for Payer: First Health Workers Compensation |
$192.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$396.90
|
| Rate for Payer: GEHA Commercial |
$352.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$396.90
|
| Rate for Payer: Humana ChoiceCare |
$114.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$173.45
|
| Rate for Payer: Multiplan All |
$401.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$264.60
|
| Rate for Payer: OMNI Networks Commercial |
$308.70
|
| Rate for Payer: One Health Plan PPO/POS |
$396.90
|
| 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 |
$418.95
|
| Rate for Payer: Three Rivers Provider Network All |
$330.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$388.08
|
| Rate for Payer: United Healthcare Commercial |
$374.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$173.45
|
| Rate for Payer: United Payors & United Providers UP&UP |
$410.13
|
| Rate for Payer: Zelis Auto |
$176.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$220.50
|
| Rate for Payer: Zelis Worker's Compensation |
$135.87
|
|
|
OT EVAL LOW COMPLEXITY/WC EVAL
|
Facility
|
IP
|
$441.00
|
|
|
Service Code
|
CPT 97165
|
| Hospital Charge Code |
4597165
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$120.39 |
| Max. Negotiated Rate |
$418.95 |
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: Cigna Commercial |
$374.85
|
| Rate for Payer: First Health Commercial |
$396.90
|
| Rate for Payer: First Health Workers Compensation |
$170.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$396.90
|
| Rate for Payer: GEHA Commercial |
$308.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$396.90
|
| Rate for Payer: Multiplan All |
$401.31
|
| Rate for Payer: OMNI Networks Commercial |
$308.70
|
| Rate for Payer: One Health Plan PPO/POS |
$396.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$418.95
|
| Rate for Payer: Three Rivers Provider Network All |
$330.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$410.13
|
| Rate for Payer: Zelis Auto |
$176.40
|
| Rate for Payer: Zelis Worker's Compensation |
$120.39
|
|
|
OT EVAL MOD COMPLEXITY
|
Facility
|
OP
|
$491.00
|
|
|
Service Code
|
CPT 97166
|
| Hospital Charge Code |
4597166
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$127.66 |
| Max. Negotiated Rate |
$466.45 |
| 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 |
$294.60
|
| 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 |
$294.60
|
| Rate for Payer: Cash Price |
$294.60
|
| Rate for Payer: Cigna Commercial |
$417.35
|
| Rate for Payer: First Health Commercial |
$441.90
|
| Rate for Payer: First Health Workers Compensation |
$192.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$441.90
|
| Rate for Payer: GEHA Commercial |
$392.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$441.90
|
| Rate for Payer: Humana ChoiceCare |
$127.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$173.45
|
| Rate for Payer: Multiplan All |
$446.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$294.60
|
| Rate for Payer: OMNI Networks Commercial |
$343.70
|
| Rate for Payer: One Health Plan PPO/POS |
$441.90
|
| 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 |
$466.45
|
| Rate for Payer: Three Rivers Provider Network All |
$368.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$432.08
|
| Rate for Payer: United Healthcare Commercial |
$417.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$173.45
|
| Rate for Payer: United Payors & United Providers UP&UP |
$456.63
|
| Rate for Payer: Zelis Auto |
$196.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$245.50
|
| Rate for Payer: Zelis Worker's Compensation |
$135.87
|
|
|
OT EVAL MOD COMPLEXITY
|
Facility
|
IP
|
$491.00
|
|
|
Service Code
|
CPT 97166
|
| Hospital Charge Code |
4597166
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$134.04 |
| Max. Negotiated Rate |
$466.45 |
| Rate for Payer: Cash Price |
$294.60
|
| Rate for Payer: Cigna Commercial |
$417.35
|
| Rate for Payer: First Health Commercial |
$441.90
|
| Rate for Payer: First Health Workers Compensation |
$189.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$441.90
|
| Rate for Payer: GEHA Commercial |
$343.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$441.90
|
| Rate for Payer: Multiplan All |
$446.81
|
| Rate for Payer: OMNI Networks Commercial |
$343.70
|
| Rate for Payer: One Health Plan PPO/POS |
$441.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$466.45
|
| Rate for Payer: Three Rivers Provider Network All |
$368.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$456.63
|
| Rate for Payer: Zelis Auto |
$196.40
|
| Rate for Payer: Zelis Worker's Compensation |
$134.04
|
|
|
OT GAIT TRAIN EA 15 MIN
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT 97116
|
| Hospital Charge Code |
4507096
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$39.22 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$62.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$96.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$62.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$49.21
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$136.00
|
| Rate for Payer: First Health Commercial |
$144.00
|
| Rate for Payer: First Health Workers Compensation |
$55.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$144.00
|
| Rate for Payer: GEHA Commercial |
$128.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$144.00
|
| Rate for Payer: Humana ChoiceCare |
$41.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$50.21
|
| Rate for Payer: Multiplan All |
$145.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$96.00
|
| Rate for Payer: OMNI Networks Commercial |
$112.00
|
| Rate for Payer: One Health Plan PPO/POS |
$144.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$57.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$50.21
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$152.00
|
| Rate for Payer: Three Rivers Provider Network All |
$120.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$140.80
|
| Rate for Payer: United Healthcare Commercial |
$136.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$50.21
|
| Rate for Payer: United Payors & United Providers UP&UP |
$148.80
|
| Rate for Payer: Zelis Auto |
$64.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$80.00
|
| Rate for Payer: Zelis Worker's Compensation |
$39.22
|
|
|
OT GAIT TRAIN EA 15 MIN
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT 97116
|
| Hospital Charge Code |
4507096
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$43.68 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$136.00
|
| Rate for Payer: First Health Commercial |
$144.00
|
| Rate for Payer: First Health Workers Compensation |
$61.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$144.00
|
| Rate for Payer: GEHA Commercial |
$112.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$144.00
|
| Rate for Payer: Multiplan All |
$145.60
|
| Rate for Payer: OMNI Networks Commercial |
$112.00
|
| Rate for Payer: One Health Plan PPO/POS |
$144.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$152.00
|
| Rate for Payer: Three Rivers Provider Network All |
$120.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$148.80
|
| Rate for Payer: Zelis Auto |
$64.00
|
| Rate for Payer: Zelis Worker's Compensation |
$43.68
|
|
|
OT HEALTH BEHAVIOR ASSESSMENT/RE-ASSESSM
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
CPT 96156
|
| Hospital Charge Code |
4500005
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$75.08 |
| Max. Negotiated Rate |
$261.25 |
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$233.75
|
| Rate for Payer: First Health Commercial |
$247.50
|
| Rate for Payer: First Health Workers Compensation |
$106.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$247.50
|
| Rate for Payer: GEHA Commercial |
$192.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$247.50
|
| Rate for Payer: Multiplan All |
$250.25
|
| Rate for Payer: OMNI Networks Commercial |
$192.50
|
| Rate for Payer: One Health Plan PPO/POS |
$247.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$261.25
|
| Rate for Payer: Three Rivers Provider Network All |
$206.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$255.75
|
| Rate for Payer: Zelis Auto |
$110.00
|
| Rate for Payer: Zelis Worker's Compensation |
$75.08
|
|
|
OT HEALTH BEHAVIOR ASSESSMENT/RE-ASSESSM
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
CPT 96156
|
| Hospital Charge Code |
4500005
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$74.66 |
| Max. Negotiated Rate |
$261.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$117.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$165.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$117.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$93.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$87.83
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$233.75
|
| Rate for Payer: First Health Commercial |
$247.50
|
| Rate for Payer: First Health Workers Compensation |
$106.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$247.50
|
| Rate for Payer: GEHA Commercial |
$220.00
|
| Rate for Payer: GEHA Medicare |
$87.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$247.50
|
| Rate for Payer: Humana ChoiceCare |
$96.61
|
| Rate for Payer: Humana Medicare Advantage |
$87.83
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$147.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$95.23
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$87.83
|
| Rate for Payer: Multiplan All |
$250.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$149.31
|
| Rate for Payer: OMNI Networks Commercial |
$192.50
|
| Rate for Payer: One Health Plan PPO/POS |
$247.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$109.96
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$95.23
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$87.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$261.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$175.66
|
| Rate for Payer: Three Rivers Provider Network All |
$206.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$86.07
|
| Rate for Payer: United Healthcare Commercial |
$233.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$95.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$87.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$255.75
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$87.83
|
| Rate for Payer: Zelis Auto |
$110.00
|
| Rate for Payer: Zelis Medicare |
$74.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$105.40
|
| Rate for Payer: Zelis Worker's Compensation |
$75.08
|
|
|
OT HEALTH/BEHAVIOR INTERVEN EA 15 MIN
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
CPT 96152
|
| Hospital Charge Code |
4590173
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$34.67 |
| Max. Negotiated Rate |
$120.65 |
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$107.95
|
| Rate for Payer: First Health Commercial |
$114.30
|
| Rate for Payer: First Health Workers Compensation |
$49.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$114.30
|
| Rate for Payer: GEHA Commercial |
$88.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$114.30
|
| Rate for Payer: Multiplan All |
$115.57
|
| Rate for Payer: OMNI Networks Commercial |
$88.90
|
| Rate for Payer: One Health Plan PPO/POS |
$114.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$120.65
|
| Rate for Payer: Three Rivers Provider Network All |
$95.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$118.11
|
| Rate for Payer: Zelis Auto |
$50.80
|
| Rate for Payer: Zelis Worker's Compensation |
$34.67
|
|
|
OT HEALTH/BEHAVIOR INTERVEN EA 15 MIN
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
CPT 96152
|
| Hospital Charge Code |
4590173
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$31.75 |
| Max. Negotiated Rate |
$120.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$76.20
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$107.95
|
| Rate for Payer: First Health Commercial |
$114.30
|
| Rate for Payer: First Health Workers Compensation |
$49.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$114.30
|
| Rate for Payer: GEHA Commercial |
$101.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$114.30
|
| Rate for Payer: Humana ChoiceCare |
$33.02
|
| Rate for Payer: Multiplan All |
$115.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$76.20
|
| Rate for Payer: OMNI Networks Commercial |
$88.90
|
| Rate for Payer: One Health Plan PPO/POS |
$114.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$120.65
|
| Rate for Payer: Three Rivers Provider Network All |
$95.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$111.76
|
| Rate for Payer: United Healthcare Commercial |
$107.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$118.11
|
| Rate for Payer: Zelis Auto |
$50.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$63.50
|
| Rate for Payer: Zelis Worker's Compensation |
$34.67
|
|
|
OT HEALTH/BEHAVIOR INTERVEN FAMILY W/
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT 96154
|
| Hospital Charge Code |
4590174
|
|
Hospital Revenue Code
|
433
|
| Min. Negotiated Rate |
$31.94 |
| Max. Negotiated Rate |
$111.15 |
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$99.45
|
| Rate for Payer: First Health Commercial |
$105.30
|
| Rate for Payer: First Health Workers Compensation |
$45.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$105.30
|
| Rate for Payer: GEHA Commercial |
$81.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$105.30
|
| Rate for Payer: Multiplan All |
$106.47
|
| Rate for Payer: OMNI Networks Commercial |
$81.90
|
| Rate for Payer: One Health Plan PPO/POS |
$105.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$111.15
|
| Rate for Payer: Three Rivers Provider Network All |
$87.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$108.81
|
| Rate for Payer: Zelis Auto |
$46.80
|
| Rate for Payer: Zelis Worker's Compensation |
$31.94
|
|
|
OT HEALTH/BEHAVIOR INTERVEN FAMILY W/
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT 96154
|
| Hospital Charge Code |
4590174
|
|
Hospital Revenue Code
|
433
|
| Min. Negotiated Rate |
$29.25 |
| Max. Negotiated Rate |
$111.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$99.45
|
| Rate for Payer: First Health Commercial |
$105.30
|
| Rate for Payer: First Health Workers Compensation |
$45.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$105.30
|
| Rate for Payer: GEHA Commercial |
$93.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$105.30
|
| Rate for Payer: Humana ChoiceCare |
$30.42
|
| Rate for Payer: Multiplan All |
$106.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$70.20
|
| Rate for Payer: OMNI Networks Commercial |
$81.90
|
| Rate for Payer: One Health Plan PPO/POS |
$105.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$111.15
|
| Rate for Payer: Three Rivers Provider Network All |
$87.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$102.96
|
| Rate for Payer: United Healthcare Commercial |
$99.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$29.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$108.81
|
| Rate for Payer: Zelis Auto |
$46.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$58.50
|
| Rate for Payer: Zelis Worker's Compensation |
$31.94
|
|
|
OT HEALTH/BEHAVIOR INTERVEN FAMILY W/O
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 96155
|
| Hospital Charge Code |
4590175
|
|
Hospital Revenue Code
|
433
|
| Min. Negotiated Rate |
$15.25 |
| Max. Negotiated Rate |
$57.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$36.60
|
| Rate for Payer: Cash Price |
$36.60
|
| Rate for Payer: Cigna Commercial |
$51.85
|
| Rate for Payer: First Health Commercial |
$54.90
|
| Rate for Payer: First Health Workers Compensation |
$23.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$54.90
|
| Rate for Payer: GEHA Commercial |
$48.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$54.90
|
| Rate for Payer: Humana ChoiceCare |
$15.86
|
| Rate for Payer: Multiplan All |
$55.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$36.60
|
| Rate for Payer: OMNI Networks Commercial |
$42.70
|
| Rate for Payer: One Health Plan PPO/POS |
$54.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$57.95
|
| Rate for Payer: Three Rivers Provider Network All |
$45.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$53.68
|
| Rate for Payer: United Healthcare Commercial |
$51.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$15.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$56.73
|
| Rate for Payer: Zelis Auto |
$24.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$30.50
|
| Rate for Payer: Zelis Worker's Compensation |
$16.65
|
|
|
OT HEALTH/BEHAVIOR INTERVEN FAMILY W/O
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT 96155
|
| Hospital Charge Code |
4590175
|
|
Hospital Revenue Code
|
433
|
| Min. Negotiated Rate |
$16.65 |
| Max. Negotiated Rate |
$57.95 |
| Rate for Payer: Cash Price |
$36.60
|
| Rate for Payer: Cigna Commercial |
$51.85
|
| Rate for Payer: First Health Commercial |
$54.90
|
| Rate for Payer: First Health Workers Compensation |
$23.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$54.90
|
| Rate for Payer: GEHA Commercial |
$42.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$54.90
|
| Rate for Payer: Multiplan All |
$55.51
|
| Rate for Payer: OMNI Networks Commercial |
$42.70
|
| Rate for Payer: One Health Plan PPO/POS |
$54.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$57.95
|
| Rate for Payer: Three Rivers Provider Network All |
$45.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$56.73
|
| Rate for Payer: Zelis Auto |
$24.40
|
| Rate for Payer: Zelis Worker's Compensation |
$16.65
|
|
|
OT HEALTH/BEHAVIOR INTERVEN GROUP
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 96153
|
| Hospital Charge Code |
4590172
|
|
Hospital Revenue Code
|
433
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$86.70
|
| Rate for Payer: First Health Commercial |
$91.80
|
| Rate for Payer: First Health Workers Compensation |
$39.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$91.80
|
| Rate for Payer: GEHA Commercial |
$81.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$91.80
|
| Rate for Payer: Humana ChoiceCare |
$26.52
|
| Rate for Payer: Multiplan All |
$92.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$61.20
|
| Rate for Payer: OMNI Networks Commercial |
$71.40
|
| Rate for Payer: One Health Plan PPO/POS |
$91.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$96.90
|
| Rate for Payer: Three Rivers Provider Network All |
$76.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$89.76
|
| Rate for Payer: United Healthcare Commercial |
$86.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$25.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$94.86
|
| Rate for Payer: Zelis Auto |
$40.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$51.00
|
| Rate for Payer: Zelis Worker's Compensation |
$27.85
|
|
|
OT HEALTH/BEHAVIOR INTERVEN GROUP
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 96153
|
| Hospital Charge Code |
4590172
|
|
Hospital Revenue Code
|
433
|
| Min. Negotiated Rate |
$27.85 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$86.70
|
| Rate for Payer: First Health Commercial |
$91.80
|
| Rate for Payer: First Health Workers Compensation |
$39.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$91.80
|
| Rate for Payer: GEHA Commercial |
$71.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$91.80
|
| Rate for Payer: Multiplan All |
$92.82
|
| Rate for Payer: OMNI Networks Commercial |
$71.40
|
| Rate for Payer: One Health Plan PPO/POS |
$91.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$96.90
|
| Rate for Payer: Three Rivers Provider Network All |
$76.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$94.86
|
| Rate for Payer: Zelis Auto |
$40.80
|
| Rate for Payer: Zelis Worker's Compensation |
$27.85
|
|
|
OT HEALTH BEHAVIOR IVNTJ IND F2F 1ST 30M
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
CPT 96158
|
| Hospital Charge Code |
4500007
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$51.05 |
| Max. Negotiated Rate |
$177.65 |
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cigna Commercial |
$158.95
|
| Rate for Payer: First Health Commercial |
$168.30
|
| Rate for Payer: First Health Workers Compensation |
$72.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$168.30
|
| Rate for Payer: GEHA Commercial |
$130.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$168.30
|
| Rate for Payer: Multiplan All |
$170.17
|
| Rate for Payer: OMNI Networks Commercial |
$130.90
|
| Rate for Payer: One Health Plan PPO/POS |
$168.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$177.65
|
| Rate for Payer: Three Rivers Provider Network All |
$140.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$173.91
|
| Rate for Payer: Zelis Auto |
$74.80
|
| Rate for Payer: Zelis Worker's Compensation |
$51.05
|
|
|
OT HEALTH BEHAVIOR IVNTJ IND F2F 1ST 30M
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
CPT 96158
|
| Hospital Charge Code |
4500007
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$51.05 |
| Max. Negotiated Rate |
$305.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$117.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$112.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$117.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$93.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$152.56
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cigna Commercial |
$158.95
|
| Rate for Payer: First Health Commercial |
$168.30
|
| Rate for Payer: First Health Workers Compensation |
$72.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$168.30
|
| Rate for Payer: GEHA Commercial |
$149.60
|
| Rate for Payer: GEHA Medicare |
$152.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$168.30
|
| Rate for Payer: Humana ChoiceCare |
$167.82
|
| Rate for Payer: Humana Medicare Advantage |
$152.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$256.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$95.23
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$152.56
|
| Rate for Payer: Multiplan All |
$170.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$259.35
|
| Rate for Payer: OMNI Networks Commercial |
$130.90
|
| Rate for Payer: One Health Plan PPO/POS |
$168.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$109.96
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$95.23
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$152.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$177.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$305.12
|
| Rate for Payer: Three Rivers Provider Network All |
$140.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$149.51
|
| Rate for Payer: United Healthcare Commercial |
$158.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$95.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$152.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$173.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$152.56
|
| Rate for Payer: Zelis Auto |
$74.80
|
| Rate for Payer: Zelis Medicare |
$129.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$183.07
|
| Rate for Payer: Zelis Worker's Compensation |
$51.05
|
|
|
OTHER BONE GRAFT MICROVASC
|
Facility
|
IP
|
$4,375.00
|
|
|
Service Code
|
CPT 20962
|
| Hospital Charge Code |
6120962
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,194.38 |
| Max. Negotiated Rate |
$4,156.25 |
| Rate for Payer: Cash Price |
$2,625.00
|
| Rate for Payer: Cigna Commercial |
$3,718.75
|
| Rate for Payer: First Health Commercial |
$3,937.50
|
| Rate for Payer: First Health Workers Compensation |
$1,689.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,937.50
|
| Rate for Payer: GEHA Commercial |
$3,062.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,937.50
|
| Rate for Payer: Multiplan All |
$3,981.25
|
| Rate for Payer: OMNI Networks Commercial |
$3,062.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,937.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,156.25
|
| Rate for Payer: Three Rivers Provider Network All |
$3,281.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,068.75
|
| Rate for Payer: Zelis Auto |
$1,750.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,194.38
|
|
|
OTHER BONE GRAFT MICROVASC
|
Facility
|
OP
|
$4,375.00
|
|
|
Service Code
|
CPT 20962
|
| Hospital Charge Code |
6120962
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,093.75 |
| Max. Negotiated Rate |
$4,156.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,625.00
|
| Rate for Payer: Cash Price |
$2,625.00
|
| Rate for Payer: Cigna Commercial |
$3,718.75
|
| Rate for Payer: First Health Commercial |
$3,937.50
|
| Rate for Payer: First Health Workers Compensation |
$1,689.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,937.50
|
| Rate for Payer: GEHA Commercial |
$3,500.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,937.50
|
| Rate for Payer: Humana ChoiceCare |
$1,137.50
|
| Rate for Payer: Multiplan All |
$3,981.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,625.00
|
| Rate for Payer: OMNI Networks Commercial |
$3,062.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,937.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,156.25
|
| Rate for Payer: Three Rivers Provider Network All |
$3,281.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,850.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,093.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,068.75
|
| Rate for Payer: Zelis Auto |
$1,750.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,187.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,194.38
|
|
|
OT HLTH BEHAVIOR IVNTJ GROUP F2F 1ST 3OM
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
CPT 96164
|
| Hospital Charge Code |
4500012
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$7.37 |
| Max. Negotiated Rate |
$56.58 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$40.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$16.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$40.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$32.46
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$28.29
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$22.95
|
| Rate for Payer: First Health Commercial |
$24.30
|
| Rate for Payer: First Health Workers Compensation |
$10.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$24.30
|
| Rate for Payer: GEHA Commercial |
$21.60
|
| Rate for Payer: GEHA Medicare |
$28.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$24.30
|
| Rate for Payer: Humana ChoiceCare |
$31.12
|
| Rate for Payer: Humana Medicare Advantage |
$28.29
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$47.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$33.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$28.29
|
| Rate for Payer: Multiplan All |
$24.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$48.09
|
| Rate for Payer: OMNI Networks Commercial |
$18.90
|
| Rate for Payer: One Health Plan PPO/POS |
$24.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$38.25
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$33.13
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$28.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$25.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$56.58
|
| Rate for Payer: Three Rivers Provider Network All |
$20.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$27.72
|
| Rate for Payer: United Healthcare Commercial |
$22.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$33.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$25.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$28.29
|
| Rate for Payer: Zelis Auto |
$10.80
|
| Rate for Payer: Zelis Medicare |
$24.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$33.95
|
| Rate for Payer: Zelis Worker's Compensation |
$7.37
|
|
|
OT HLTH BEHAVIOR IVNTJ GROUP F2F 1ST 3OM
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
CPT 96164
|
| Hospital Charge Code |
4500012
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$7.37 |
| Max. Negotiated Rate |
$25.65 |
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$22.95
|
| Rate for Payer: First Health Commercial |
$24.30
|
| Rate for Payer: First Health Workers Compensation |
$10.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$24.30
|
| Rate for Payer: GEHA Commercial |
$18.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$24.30
|
| Rate for Payer: Multiplan All |
$24.57
|
| Rate for Payer: OMNI Networks Commercial |
$18.90
|
| Rate for Payer: One Health Plan PPO/POS |
$24.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$25.65
|
| Rate for Payer: Three Rivers Provider Network All |
$20.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$25.11
|
| Rate for Payer: Zelis Auto |
$10.80
|
| Rate for Payer: Zelis Worker's Compensation |
$7.37
|
|
|
OT HLTH BEHAVIOR IVNTJ IND F2F EA AD 15M
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 96159
|
| Hospital Charge Code |
4500009
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$61.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$55.25
|
| Rate for Payer: First Health Commercial |
$58.50
|
| Rate for Payer: First Health Workers Compensation |
$25.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$58.50
|
| Rate for Payer: GEHA Commercial |
$52.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$58.50
|
| Rate for Payer: Humana ChoiceCare |
$16.90
|
| Rate for Payer: Multiplan All |
$59.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$39.00
|
| Rate for Payer: OMNI Networks Commercial |
$45.50
|
| Rate for Payer: One Health Plan PPO/POS |
$58.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$61.75
|
| Rate for Payer: Three Rivers Provider Network All |
$48.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$57.20
|
| Rate for Payer: United Healthcare Commercial |
$55.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$60.45
|
| Rate for Payer: Zelis Auto |
$26.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$32.50
|
| Rate for Payer: Zelis Worker's Compensation |
$17.75
|
|
|
OT HLTH BEHAVIOR IVNTJ IND F2F EA AD 15M
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
CPT 96159
|
| Hospital Charge Code |
4500009
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$17.75 |
| Max. Negotiated Rate |
$61.75 |
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$55.25
|
| Rate for Payer: First Health Commercial |
$58.50
|
| Rate for Payer: First Health Workers Compensation |
$25.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$58.50
|
| Rate for Payer: GEHA Commercial |
$45.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$58.50
|
| Rate for Payer: Multiplan All |
$59.15
|
| Rate for Payer: OMNI Networks Commercial |
$45.50
|
| Rate for Payer: One Health Plan PPO/POS |
$58.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$61.75
|
| Rate for Payer: Three Rivers Provider Network All |
$48.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$60.45
|
| Rate for Payer: Zelis Auto |
$26.00
|
| Rate for Payer: Zelis Worker's Compensation |
$17.75
|
|
|
OT HLTH BHAVIOR IVNTJ GRP F2F EA AD 15M
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 96165
|
| Hospital Charge Code |
4500014
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$11.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$10.20
|
| Rate for Payer: First Health Commercial |
$10.80
|
| Rate for Payer: First Health Workers Compensation |
$4.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10.80
|
| Rate for Payer: GEHA Commercial |
$9.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10.80
|
| Rate for Payer: Humana ChoiceCare |
$3.12
|
| Rate for Payer: Multiplan All |
$10.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7.20
|
| Rate for Payer: OMNI Networks Commercial |
$8.40
|
| Rate for Payer: One Health Plan PPO/POS |
$10.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$11.40
|
| Rate for Payer: Three Rivers Provider Network All |
$9.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10.56
|
| Rate for Payer: United Healthcare Commercial |
$10.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$11.16
|
| Rate for Payer: Zelis Auto |
$4.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.00
|
| Rate for Payer: Zelis Worker's Compensation |
$3.28
|
|
