|
OT PARAFFIN BATH THERAPY
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT 97018
|
| Hospital Charge Code |
4590176
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$7.47 |
| Max. Negotiated Rate |
$111.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$11.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$70.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$11.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$9.48
|
| Rate for Payer: Cash Price |
$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 |
$10.56
|
| 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: Molina Healthcare of New Mexico Medicaid |
$9.68
|
| 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: Presbyterian Health Plan Exchange |
$11.17
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$9.68
|
| 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 |
$9.68
|
| 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 |
$7.47
|
|
|
OT PARAFFIN BATH THERAPY
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT 97018
|
| Hospital Charge Code |
4590176
|
|
Hospital Revenue Code
|
430
|
| 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 PHYS PERFORMANCE TEST
|
Facility
|
IP
|
$436.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
4590188
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$119.03 |
| Max. Negotiated Rate |
$414.20 |
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cigna Commercial |
$370.60
|
| Rate for Payer: First Health Commercial |
$392.40
|
| Rate for Payer: First Health Workers Compensation |
$168.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$392.40
|
| Rate for Payer: GEHA Commercial |
$305.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$392.40
|
| Rate for Payer: Multiplan All |
$396.76
|
| Rate for Payer: OMNI Networks Commercial |
$305.20
|
| Rate for Payer: One Health Plan PPO/POS |
$392.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$414.20
|
| Rate for Payer: Three Rivers Provider Network All |
$327.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$405.48
|
| Rate for Payer: Zelis Auto |
$174.40
|
| Rate for Payer: Zelis Worker's Compensation |
$119.03
|
|
|
OT PHYS PERFORMANCE TEST
|
Facility
|
OP
|
$436.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
4590188
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$34.47 |
| Max. Negotiated Rate |
$414.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$43.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$261.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$43.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$34.47
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cigna Commercial |
$370.60
|
| Rate for Payer: First Health Commercial |
$392.40
|
| Rate for Payer: First Health Workers Compensation |
$64.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$392.40
|
| Rate for Payer: GEHA Commercial |
$348.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$392.40
|
| Rate for Payer: Humana ChoiceCare |
$113.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$35.17
|
| Rate for Payer: Multiplan All |
$396.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$261.60
|
| Rate for Payer: OMNI Networks Commercial |
$305.20
|
| Rate for Payer: One Health Plan PPO/POS |
$392.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$40.61
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$35.17
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$414.20
|
| Rate for Payer: Three Rivers Provider Network All |
$327.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$383.68
|
| Rate for Payer: United Healthcare Commercial |
$370.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$35.17
|
| Rate for Payer: United Payors & United Providers UP&UP |
$405.48
|
| Rate for Payer: Zelis Auto |
$174.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$218.00
|
| Rate for Payer: Zelis Worker's Compensation |
$45.29
|
|
|
OT PROSTHETIC TNG 15MIN
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
CPT 97761
|
| Hospital Charge Code |
4507202
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$40.30 |
| Max. Negotiated Rate |
$147.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$87.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$93.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$87.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$69.09
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$131.75
|
| Rate for Payer: First Health Commercial |
$139.50
|
| Rate for Payer: First Health Workers Compensation |
$77.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$139.50
|
| Rate for Payer: GEHA Commercial |
$124.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$139.50
|
| Rate for Payer: Humana ChoiceCare |
$40.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$70.49
|
| Rate for Payer: Multiplan All |
$141.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$93.00
|
| Rate for Payer: OMNI Networks Commercial |
$108.50
|
| Rate for Payer: One Health Plan PPO/POS |
$139.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$81.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$70.49
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$147.25
|
| Rate for Payer: Three Rivers Provider Network All |
$116.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$136.40
|
| Rate for Payer: United Healthcare Commercial |
$131.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$70.49
|
| Rate for Payer: United Payors & United Providers UP&UP |
$144.15
|
| Rate for Payer: Zelis Auto |
$62.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$77.50
|
| Rate for Payer: Zelis Worker's Compensation |
$55.10
|
|
|
OT PROSTHETIC TNG 15MIN
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
CPT 97761
|
| Hospital Charge Code |
4507202
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$42.31 |
| Max. Negotiated Rate |
$147.25 |
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$131.75
|
| Rate for Payer: First Health Commercial |
$139.50
|
| Rate for Payer: First Health Workers Compensation |
$59.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$139.50
|
| Rate for Payer: GEHA Commercial |
$108.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$139.50
|
| Rate for Payer: Multiplan All |
$141.05
|
| Rate for Payer: OMNI Networks Commercial |
$108.50
|
| Rate for Payer: One Health Plan PPO/POS |
$139.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$147.25
|
| Rate for Payer: Three Rivers Provider Network All |
$116.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$144.15
|
| Rate for Payer: Zelis Auto |
$62.00
|
| Rate for Payer: Zelis Worker's Compensation |
$42.31
|
|
|
OT RANGE OF MOTION MEASUREMENTS AND REPO
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 95851
|
| Hospital Charge Code |
4595851
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$28.48 |
| Max. Negotiated Rate |
$207.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$120.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$130.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$120.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$95.84
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cigna Commercial |
$185.30
|
| Rate for Payer: First Health Commercial |
$196.20
|
| Rate for Payer: First Health Workers Compensation |
$40.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$196.20
|
| Rate for Payer: GEHA Commercial |
$174.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$196.20
|
| Rate for Payer: Humana ChoiceCare |
$56.68
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$97.79
|
| Rate for Payer: Multiplan All |
$198.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$130.80
|
| Rate for Payer: OMNI Networks Commercial |
$152.60
|
| Rate for Payer: One Health Plan PPO/POS |
$196.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$112.91
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$97.79
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$207.10
|
| Rate for Payer: Three Rivers Provider Network All |
$163.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$191.84
|
| Rate for Payer: United Healthcare Commercial |
$185.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$97.79
|
| Rate for Payer: United Payors & United Providers UP&UP |
$202.74
|
| Rate for Payer: Zelis Auto |
$87.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$109.00
|
| Rate for Payer: Zelis Worker's Compensation |
$28.48
|
|
|
OT RANGE OF MOTION MEASUREMENTS AND REPO
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 95851
|
| Hospital Charge Code |
4595851
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$59.51 |
| Max. Negotiated Rate |
$207.10 |
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cigna Commercial |
$185.30
|
| Rate for Payer: First Health Commercial |
$196.20
|
| Rate for Payer: First Health Workers Compensation |
$84.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$196.20
|
| Rate for Payer: GEHA Commercial |
$152.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$196.20
|
| Rate for Payer: Multiplan All |
$198.38
|
| Rate for Payer: OMNI Networks Commercial |
$152.60
|
| Rate for Payer: One Health Plan PPO/POS |
$196.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$207.10
|
| Rate for Payer: Three Rivers Provider Network All |
$163.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$202.74
|
| Rate for Payer: Zelis Auto |
$87.20
|
| Rate for Payer: Zelis Worker's Compensation |
$59.51
|
|
|
OT RE EVALUATION
|
Facility
|
IP
|
$441.00
|
|
|
Service Code
|
CPT 97168
|
| Hospital Charge Code |
4597168
|
|
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 RE EVALUATION
|
Facility
|
OP
|
$441.00
|
|
|
Service Code
|
CPT 97168
|
| Hospital Charge Code |
4597168
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$93.38 |
| Max. Negotiated Rate |
$418.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.57
|
| 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 |
$147.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$116.90
|
| 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 |
$132.07
|
| 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 |
$119.29
|
| 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 |
$137.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.29
|
| 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 |
$119.29
|
| 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 |
$93.38
|
|
|
OT ROM MEASUREMENTS/HAND
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT 95852
|
| Hospital Charge Code |
4500029
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$23.34 |
| Max. Negotiated Rate |
$130.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$120.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$82.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$120.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$95.84
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$116.45
|
| Rate for Payer: First Health Commercial |
$123.30
|
| Rate for Payer: First Health Workers Compensation |
$33.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$123.30
|
| Rate for Payer: GEHA Commercial |
$109.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$123.30
|
| Rate for Payer: Humana ChoiceCare |
$35.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$97.79
|
| Rate for Payer: Multiplan All |
$124.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$82.20
|
| Rate for Payer: OMNI Networks Commercial |
$95.90
|
| Rate for Payer: One Health Plan PPO/POS |
$123.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$112.91
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$97.79
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$130.15
|
| Rate for Payer: Three Rivers Provider Network All |
$102.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$120.56
|
| Rate for Payer: United Healthcare Commercial |
$116.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$97.79
|
| Rate for Payer: United Payors & United Providers UP&UP |
$127.41
|
| Rate for Payer: Zelis Auto |
$54.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$68.50
|
| Rate for Payer: Zelis Worker's Compensation |
$23.34
|
|
|
OT ROM MEASUREMENTS/HAND
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT 95852
|
| Hospital Charge Code |
4500029
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$37.40 |
| Max. Negotiated Rate |
$130.15 |
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$116.45
|
| Rate for Payer: First Health Commercial |
$123.30
|
| Rate for Payer: First Health Workers Compensation |
$52.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$123.30
|
| Rate for Payer: GEHA Commercial |
$95.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$123.30
|
| Rate for Payer: Multiplan All |
$124.67
|
| Rate for Payer: OMNI Networks Commercial |
$95.90
|
| Rate for Payer: One Health Plan PPO/POS |
$123.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$130.15
|
| Rate for Payer: Three Rivers Provider Network All |
$102.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$127.41
|
| Rate for Payer: Zelis Auto |
$54.80
|
| Rate for Payer: Zelis Worker's Compensation |
$37.40
|
|
|
OT SENSORY INTEGRATION
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
CPT 97533
|
| Hospital Charge Code |
4500027
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$30.35 |
| Max. Negotiated Rate |
$120.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$38.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$76.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$38.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$30.35
|
| Rate for Payer: Cash Price |
$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 |
$114.90
|
| 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: Molina Healthcare of New Mexico Medicaid |
$30.97
|
| 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: Presbyterian Health Plan Exchange |
$35.76
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$30.97
|
| 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 |
$30.97
|
| 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 |
$81.24
|
|
|
OT SENSORY INTEGRATION
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
CPT 97533
|
| Hospital Charge Code |
4500027
|
|
Hospital Revenue Code
|
430
|
| 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 STANDARD COGNITIVE PERF TEST PER HR
|
Facility
|
OP
|
$401.00
|
|
|
Service Code
|
CPT 96125
|
| Hospital Charge Code |
4590171
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$73.07 |
| Max. Negotiated Rate |
$380.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$92.23
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$240.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$92.23
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$73.07
|
| Rate for Payer: Cash Price |
$240.60
|
| Rate for Payer: Cash Price |
$240.60
|
| Rate for Payer: Cigna Commercial |
$340.85
|
| Rate for Payer: First Health Commercial |
$360.90
|
| Rate for Payer: First Health Workers Compensation |
$154.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$360.90
|
| Rate for Payer: GEHA Commercial |
$320.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$360.90
|
| Rate for Payer: Humana ChoiceCare |
$104.26
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$74.56
|
| Rate for Payer: Multiplan All |
$364.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$240.60
|
| Rate for Payer: OMNI Networks Commercial |
$280.70
|
| Rate for Payer: One Health Plan PPO/POS |
$360.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$86.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$74.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$380.95
|
| Rate for Payer: Three Rivers Provider Network All |
$300.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$352.88
|
| Rate for Payer: United Healthcare Commercial |
$340.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$74.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$372.93
|
| Rate for Payer: Zelis Auto |
$160.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$200.50
|
| Rate for Payer: Zelis Worker's Compensation |
$109.47
|
|
|
OT STANDARD COGNITIVE PERF TEST PER HR
|
Facility
|
IP
|
$401.00
|
|
|
Service Code
|
CPT 96125
|
| Hospital Charge Code |
4590171
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$109.47 |
| Max. Negotiated Rate |
$380.95 |
| Rate for Payer: Cash Price |
$240.60
|
| Rate for Payer: Cigna Commercial |
$340.85
|
| Rate for Payer: First Health Commercial |
$360.90
|
| Rate for Payer: First Health Workers Compensation |
$154.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$360.90
|
| Rate for Payer: GEHA Commercial |
$280.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$360.90
|
| Rate for Payer: Multiplan All |
$364.91
|
| Rate for Payer: OMNI Networks Commercial |
$280.70
|
| Rate for Payer: One Health Plan PPO/POS |
$360.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$380.95
|
| Rate for Payer: Three Rivers Provider Network All |
$300.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$372.93
|
| Rate for Payer: Zelis Auto |
$160.40
|
| Rate for Payer: Zelis Worker's Compensation |
$109.47
|
|
|
OT SW EVAL
|
Facility
|
IP
|
$567.00
|
|
|
Service Code
|
CPT 92610
|
| Hospital Charge Code |
4503033
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$154.79 |
| Max. Negotiated Rate |
$538.65 |
| Rate for Payer: Cash Price |
$340.20
|
| Rate for Payer: Cigna Commercial |
$481.95
|
| Rate for Payer: First Health Commercial |
$510.30
|
| Rate for Payer: First Health Workers Compensation |
$218.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$510.30
|
| Rate for Payer: GEHA Commercial |
$396.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$510.30
|
| Rate for Payer: Multiplan All |
$515.97
|
| Rate for Payer: OMNI Networks Commercial |
$396.90
|
| Rate for Payer: One Health Plan PPO/POS |
$510.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$538.65
|
| Rate for Payer: Three Rivers Provider Network All |
$425.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$527.31
|
| Rate for Payer: Zelis Auto |
$226.80
|
| Rate for Payer: Zelis Worker's Compensation |
$154.79
|
|
|
OT SW EVAL
|
Facility
|
OP
|
$567.00
|
|
|
Service Code
|
CPT 92610
|
| Hospital Charge Code |
4503033
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$101.53 |
| Max. Negotiated Rate |
$538.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$128.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$340.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$128.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$101.53
|
| Rate for Payer: Cash Price |
$340.20
|
| Rate for Payer: Cash Price |
$340.20
|
| Rate for Payer: Cigna Commercial |
$481.95
|
| Rate for Payer: First Health Commercial |
$510.30
|
| Rate for Payer: First Health Workers Compensation |
$218.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$510.30
|
| Rate for Payer: GEHA Commercial |
$453.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$510.30
|
| Rate for Payer: Humana ChoiceCare |
$147.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$103.60
|
| Rate for Payer: Multiplan All |
$515.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$340.20
|
| Rate for Payer: OMNI Networks Commercial |
$396.90
|
| Rate for Payer: One Health Plan PPO/POS |
$510.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$119.62
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$103.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$538.65
|
| Rate for Payer: Three Rivers Provider Network All |
$425.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$498.96
|
| Rate for Payer: United Healthcare Commercial |
$481.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$103.60
|
| Rate for Payer: United Payors & United Providers UP&UP |
$527.31
|
| Rate for Payer: Zelis Auto |
$226.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$283.50
|
| Rate for Payer: Zelis Worker's Compensation |
$154.79
|
|
|
OT SW TREATMENT
|
Facility
|
IP
|
$385.00
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
4503032
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$105.11 |
| Max. Negotiated Rate |
$365.75 |
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cigna Commercial |
$327.25
|
| Rate for Payer: First Health Commercial |
$346.50
|
| Rate for Payer: First Health Workers Compensation |
$148.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$346.50
|
| Rate for Payer: GEHA Commercial |
$269.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$346.50
|
| Rate for Payer: Multiplan All |
$350.35
|
| Rate for Payer: OMNI Networks Commercial |
$269.50
|
| Rate for Payer: One Health Plan PPO/POS |
$346.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$365.75
|
| Rate for Payer: Three Rivers Provider Network All |
$288.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$358.05
|
| Rate for Payer: Zelis Auto |
$154.00
|
| Rate for Payer: Zelis Worker's Compensation |
$105.11
|
|
|
OT SW TREATMENT
|
Facility
|
OP
|
$385.00
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
4503032
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$92.77 |
| Max. Negotiated Rate |
$365.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$117.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$231.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$117.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$92.77
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cigna Commercial |
$327.25
|
| Rate for Payer: First Health Commercial |
$346.50
|
| Rate for Payer: First Health Workers Compensation |
$148.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$346.50
|
| Rate for Payer: GEHA Commercial |
$308.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$346.50
|
| Rate for Payer: Humana ChoiceCare |
$100.10
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$94.66
|
| Rate for Payer: Multiplan All |
$350.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$231.00
|
| Rate for Payer: OMNI Networks Commercial |
$269.50
|
| Rate for Payer: One Health Plan PPO/POS |
$346.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$109.30
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$94.66
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$365.75
|
| Rate for Payer: Three Rivers Provider Network All |
$288.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$338.80
|
| Rate for Payer: United Healthcare Commercial |
$327.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$94.66
|
| Rate for Payer: United Payors & United Providers UP&UP |
$358.05
|
| Rate for Payer: Zelis Auto |
$154.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$192.50
|
| Rate for Payer: Zelis Worker's Compensation |
$105.11
|
|
|
OT THERAPEUTIC ACTIVITES
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 97530
|
| Hospital Charge Code |
4590181
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$33.62 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$42.44
|
| 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 |
$42.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$33.62
|
| 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 |
$68.68
|
| 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 |
$34.30
|
| 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 |
$39.61
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$34.30
|
| 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 |
$34.30
|
| 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 |
$48.56
|
|
|
OT THERAPEUTIC ACTIVITES
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 97530
|
| Hospital Charge Code |
4590181
|
|
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
|
|
|
OT THERAP GROUP 2 OR MO
|
Facility
|
OP
|
$208.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
4500061
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$24.28 |
| Max. Negotiated Rate |
$197.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$38.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$124.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$38.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$30.33
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cigna Commercial |
$176.80
|
| Rate for Payer: First Health Commercial |
$187.20
|
| Rate for Payer: First Health Workers Compensation |
$34.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$187.20
|
| Rate for Payer: GEHA Commercial |
$166.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$187.20
|
| Rate for Payer: Humana ChoiceCare |
$54.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$30.94
|
| Rate for Payer: Multiplan All |
$189.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$124.80
|
| Rate for Payer: OMNI Networks Commercial |
$145.60
|
| Rate for Payer: One Health Plan PPO/POS |
$187.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$35.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$30.94
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$197.60
|
| Rate for Payer: Three Rivers Provider Network All |
$156.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$183.04
|
| Rate for Payer: United Healthcare Commercial |
$176.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$30.94
|
| Rate for Payer: United Payors & United Providers UP&UP |
$193.44
|
| Rate for Payer: Zelis Auto |
$83.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$104.00
|
| Rate for Payer: Zelis Worker's Compensation |
$24.28
|
|
|
OT THERAP GROUP 2 OR MO
|
Facility
|
IP
|
$208.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
4500061
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$56.78 |
| Max. Negotiated Rate |
$197.60 |
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cigna Commercial |
$176.80
|
| Rate for Payer: First Health Commercial |
$187.20
|
| Rate for Payer: First Health Workers Compensation |
$80.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$187.20
|
| Rate for Payer: GEHA Commercial |
$145.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$187.20
|
| Rate for Payer: Multiplan All |
$189.28
|
| Rate for Payer: OMNI Networks Commercial |
$145.60
|
| Rate for Payer: One Health Plan PPO/POS |
$187.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$197.60
|
| Rate for Payer: Three Rivers Provider Network All |
$156.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$193.44
|
| Rate for Payer: Zelis Auto |
$83.20
|
| Rate for Payer: Zelis Worker's Compensation |
$56.78
|
|
|
OT THERAPTC MASSGE E15M
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 97124
|
| Hospital Charge Code |
4500044
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$142.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$63.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$90.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$63.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$50.27
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$127.50
|
| Rate for Payer: First Health Commercial |
$135.00
|
| Rate for Payer: First Health Workers Compensation |
$56.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$135.00
|
| Rate for Payer: GEHA Commercial |
$120.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$135.00
|
| Rate for Payer: Humana ChoiceCare |
$39.00
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$51.29
|
| Rate for Payer: Multiplan All |
$136.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$90.00
|
| Rate for Payer: OMNI Networks Commercial |
$105.00
|
| Rate for Payer: One Health Plan PPO/POS |
$135.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$59.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$51.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$142.50
|
| Rate for Payer: Three Rivers Provider Network All |
$112.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$132.00
|
| Rate for Payer: United Healthcare Commercial |
$127.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$51.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$139.50
|
| Rate for Payer: Zelis Auto |
$60.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$75.00
|
| Rate for Payer: Zelis Worker's Compensation |
$40.15
|
|
