|
PHYS/QHP TELEPHONE EVALUATION 11-20 MIN
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT 99442
|
| Hospital Charge Code |
9299442
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$39.25 |
| Max. Negotiated Rate |
$149.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$94.20
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$133.45
|
| Rate for Payer: First Health Commercial |
$141.30
|
| Rate for Payer: First Health Workers Compensation |
$60.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$141.30
|
| Rate for Payer: GEHA Commercial |
$125.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$141.30
|
| Rate for Payer: Humana ChoiceCare |
$40.82
|
| Rate for Payer: Multiplan All |
$142.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$94.20
|
| Rate for Payer: OMNI Networks Commercial |
$109.90
|
| Rate for Payer: One Health Plan PPO/POS |
$141.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$149.15
|
| Rate for Payer: Three Rivers Provider Network All |
$117.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$138.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$39.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$146.01
|
| Rate for Payer: Zelis Auto |
$62.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$78.50
|
| Rate for Payer: Zelis Worker's Compensation |
$42.86
|
|
|
PHYS/QHP TELEPHONE EVALUATION 21-30 MIN
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 99443
|
| Hospital Charge Code |
7999443
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$36.58 |
| Max. Negotiated Rate |
$127.30 |
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna Commercial |
$113.90
|
| Rate for Payer: First Health Commercial |
$120.60
|
| Rate for Payer: First Health Workers Compensation |
$51.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$120.60
|
| Rate for Payer: GEHA Commercial |
$93.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$120.60
|
| Rate for Payer: Multiplan All |
$121.94
|
| Rate for Payer: OMNI Networks Commercial |
$93.80
|
| Rate for Payer: One Health Plan PPO/POS |
$120.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$127.30
|
| Rate for Payer: Three Rivers Provider Network All |
$100.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$124.62
|
| Rate for Payer: Zelis Auto |
$53.60
|
| Rate for Payer: Zelis Worker's Compensation |
$36.58
|
|
|
PHYS/QHP TELEPHONE EVALUATION 21-30 MIN
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 99443
|
| Hospital Charge Code |
9699443
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$60.50 |
| Max. Negotiated Rate |
$229.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$145.20
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$205.70
|
| Rate for Payer: First Health Commercial |
$217.80
|
| Rate for Payer: First Health Workers Compensation |
$93.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$217.80
|
| Rate for Payer: GEHA Commercial |
$193.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$217.80
|
| Rate for Payer: Humana ChoiceCare |
$62.92
|
| Rate for Payer: Multiplan All |
$220.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$145.20
|
| Rate for Payer: OMNI Networks Commercial |
$169.40
|
| Rate for Payer: One Health Plan PPO/POS |
$217.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$229.90
|
| Rate for Payer: Three Rivers Provider Network All |
$181.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$212.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$60.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$225.06
|
| Rate for Payer: Zelis Auto |
$96.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.00
|
| Rate for Payer: Zelis Worker's Compensation |
$66.07
|
|
|
PHYS/QHP TELEPHONE EVALUATION 21-30 MIN
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 99443
|
| Hospital Charge Code |
8899443
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$60.50 |
| Max. Negotiated Rate |
$229.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$145.20
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$205.70
|
| Rate for Payer: First Health Commercial |
$217.80
|
| Rate for Payer: First Health Workers Compensation |
$93.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$217.80
|
| Rate for Payer: GEHA Commercial |
$193.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$217.80
|
| Rate for Payer: Humana ChoiceCare |
$62.92
|
| Rate for Payer: Multiplan All |
$220.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$145.20
|
| Rate for Payer: OMNI Networks Commercial |
$169.40
|
| Rate for Payer: One Health Plan PPO/POS |
$217.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$229.90
|
| Rate for Payer: Three Rivers Provider Network All |
$181.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$212.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$60.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$225.06
|
| Rate for Payer: Zelis Auto |
$96.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.00
|
| Rate for Payer: Zelis Worker's Compensation |
$66.07
|
|
|
PHYS/QHP TELEPHONE EVALUATION 21-30 MIN
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 99443
|
| Hospital Charge Code |
7600017
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$60.50 |
| Max. Negotiated Rate |
$229.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$145.20
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$205.70
|
| Rate for Payer: First Health Commercial |
$217.80
|
| Rate for Payer: First Health Workers Compensation |
$93.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$217.80
|
| Rate for Payer: GEHA Commercial |
$193.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$217.80
|
| Rate for Payer: Humana ChoiceCare |
$62.92
|
| Rate for Payer: Multiplan All |
$220.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$145.20
|
| Rate for Payer: OMNI Networks Commercial |
$169.40
|
| Rate for Payer: One Health Plan PPO/POS |
$217.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$229.90
|
| Rate for Payer: Three Rivers Provider Network All |
$181.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$212.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$60.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$225.06
|
| Rate for Payer: Zelis Auto |
$96.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.00
|
| Rate for Payer: Zelis Worker's Compensation |
$66.07
|
|
|
PHYS/QHP TELEPHONE EVALUATION 21-30 MIN
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 99443
|
| Hospital Charge Code |
7600017
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$66.07 |
| Max. Negotiated Rate |
$229.90 |
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$205.70
|
| Rate for Payer: First Health Commercial |
$217.80
|
| Rate for Payer: First Health Workers Compensation |
$93.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$217.80
|
| Rate for Payer: GEHA Commercial |
$169.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$217.80
|
| Rate for Payer: Multiplan All |
$220.22
|
| Rate for Payer: OMNI Networks Commercial |
$169.40
|
| Rate for Payer: One Health Plan PPO/POS |
$217.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$229.90
|
| Rate for Payer: Three Rivers Provider Network All |
$181.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$225.06
|
| Rate for Payer: Zelis Auto |
$96.80
|
| Rate for Payer: Zelis Worker's Compensation |
$66.07
|
|
|
PHYS/QHP TELEPHONE EVALUATION 21-30 MIN
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 99443
|
| Hospital Charge Code |
8899443
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$66.07 |
| Max. Negotiated Rate |
$229.90 |
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$205.70
|
| Rate for Payer: First Health Commercial |
$217.80
|
| Rate for Payer: First Health Workers Compensation |
$93.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$217.80
|
| Rate for Payer: GEHA Commercial |
$169.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$217.80
|
| Rate for Payer: Multiplan All |
$220.22
|
| Rate for Payer: OMNI Networks Commercial |
$169.40
|
| Rate for Payer: One Health Plan PPO/POS |
$217.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$229.90
|
| Rate for Payer: Three Rivers Provider Network All |
$181.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$225.06
|
| Rate for Payer: Zelis Auto |
$96.80
|
| Rate for Payer: Zelis Worker's Compensation |
$66.07
|
|
|
PHYS/QHP TELEPHONE EVALUATION 21-30 MIN
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 99443
|
| Hospital Charge Code |
9599443
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$36.58 |
| Max. Negotiated Rate |
$127.30 |
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna Commercial |
$113.90
|
| Rate for Payer: First Health Commercial |
$120.60
|
| Rate for Payer: First Health Workers Compensation |
$51.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$120.60
|
| Rate for Payer: GEHA Commercial |
$93.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$120.60
|
| Rate for Payer: Multiplan All |
$121.94
|
| Rate for Payer: OMNI Networks Commercial |
$93.80
|
| Rate for Payer: One Health Plan PPO/POS |
$120.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$127.30
|
| Rate for Payer: Three Rivers Provider Network All |
$100.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$124.62
|
| Rate for Payer: Zelis Auto |
$53.60
|
| Rate for Payer: Zelis Worker's Compensation |
$36.58
|
|
|
PHYS/QHP TELEPHONE EVALUATION 21-30 MIN
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
CPT 99443
|
| Hospital Charge Code |
1900064
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$80.26 |
| Max. Negotiated Rate |
$279.30 |
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna Commercial |
$249.90
|
| Rate for Payer: First Health Commercial |
$264.60
|
| Rate for Payer: First Health Workers Compensation |
$113.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$264.60
|
| Rate for Payer: GEHA Commercial |
$205.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$264.60
|
| Rate for Payer: Multiplan All |
$267.54
|
| Rate for Payer: OMNI Networks Commercial |
$205.80
|
| Rate for Payer: One Health Plan PPO/POS |
$264.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$279.30
|
| Rate for Payer: Three Rivers Provider Network All |
$220.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$273.42
|
| Rate for Payer: Zelis Auto |
$117.60
|
| Rate for Payer: Zelis Worker's Compensation |
$80.26
|
|
|
PHYS/QHP TELEPHONE EVALUATION 21-30 MIN
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT 99443
|
| Hospital Charge Code |
9599443
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$33.50 |
| Max. Negotiated Rate |
$127.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna Commercial |
$113.90
|
| Rate for Payer: First Health Commercial |
$120.60
|
| Rate for Payer: First Health Workers Compensation |
$51.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$120.60
|
| Rate for Payer: GEHA Commercial |
$107.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$120.60
|
| Rate for Payer: Humana ChoiceCare |
$34.84
|
| Rate for Payer: Multiplan All |
$121.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$80.40
|
| Rate for Payer: OMNI Networks Commercial |
$93.80
|
| Rate for Payer: One Health Plan PPO/POS |
$120.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$127.30
|
| Rate for Payer: Three Rivers Provider Network All |
$100.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$117.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$33.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$124.62
|
| Rate for Payer: Zelis Auto |
$53.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$67.00
|
| Rate for Payer: Zelis Worker's Compensation |
$36.58
|
|
|
PHYS/QHP TELEPHONE EVALUATION 21-30 MIN
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 99443
|
| Hospital Charge Code |
21099443
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$66.07 |
| Max. Negotiated Rate |
$229.90 |
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$205.70
|
| Rate for Payer: First Health Commercial |
$217.80
|
| Rate for Payer: First Health Workers Compensation |
$93.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$217.80
|
| Rate for Payer: GEHA Commercial |
$169.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$217.80
|
| Rate for Payer: Multiplan All |
$220.22
|
| Rate for Payer: OMNI Networks Commercial |
$169.40
|
| Rate for Payer: One Health Plan PPO/POS |
$217.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$229.90
|
| Rate for Payer: Three Rivers Provider Network All |
$181.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$225.06
|
| Rate for Payer: Zelis Auto |
$96.80
|
| Rate for Payer: Zelis Worker's Compensation |
$66.07
|
|
|
PHYS/QHP TELEPHONE EVALUATION 21-30 MIN
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT 99443
|
| Hospital Charge Code |
8799443
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$33.50 |
| Max. Negotiated Rate |
$127.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna Commercial |
$113.90
|
| Rate for Payer: First Health Commercial |
$120.60
|
| Rate for Payer: First Health Workers Compensation |
$51.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$120.60
|
| Rate for Payer: GEHA Commercial |
$107.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$120.60
|
| Rate for Payer: Humana ChoiceCare |
$34.84
|
| Rate for Payer: Multiplan All |
$121.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$80.40
|
| Rate for Payer: OMNI Networks Commercial |
$93.80
|
| Rate for Payer: One Health Plan PPO/POS |
$120.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$127.30
|
| Rate for Payer: Three Rivers Provider Network All |
$100.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$117.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$33.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$124.62
|
| Rate for Payer: Zelis Auto |
$53.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$67.00
|
| Rate for Payer: Zelis Worker's Compensation |
$36.58
|
|
|
PHYS/QHP TELEPHONE EVALUATION 21-30 MIN
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 99443
|
| Hospital Charge Code |
8299443
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$66.07 |
| Max. Negotiated Rate |
$229.90 |
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$205.70
|
| Rate for Payer: First Health Commercial |
$217.80
|
| Rate for Payer: First Health Workers Compensation |
$93.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$217.80
|
| Rate for Payer: GEHA Commercial |
$169.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$217.80
|
| Rate for Payer: Multiplan All |
$220.22
|
| Rate for Payer: OMNI Networks Commercial |
$169.40
|
| Rate for Payer: One Health Plan PPO/POS |
$217.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$229.90
|
| Rate for Payer: Three Rivers Provider Network All |
$181.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$225.06
|
| Rate for Payer: Zelis Auto |
$96.80
|
| Rate for Payer: Zelis Worker's Compensation |
$66.07
|
|
|
PHYS/QHP TELEPHONE EVALUATION 21-30 MIN
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 99443
|
| Hospital Charge Code |
21900178
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$60.50 |
| Max. Negotiated Rate |
$229.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$145.20
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$205.70
|
| Rate for Payer: First Health Commercial |
$217.80
|
| Rate for Payer: First Health Workers Compensation |
$93.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$217.80
|
| Rate for Payer: GEHA Commercial |
$193.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$217.80
|
| Rate for Payer: Humana ChoiceCare |
$62.92
|
| Rate for Payer: Multiplan All |
$220.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$145.20
|
| Rate for Payer: OMNI Networks Commercial |
$169.40
|
| Rate for Payer: One Health Plan PPO/POS |
$217.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$229.90
|
| Rate for Payer: Three Rivers Provider Network All |
$181.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$212.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$60.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$225.06
|
| Rate for Payer: Zelis Auto |
$96.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.00
|
| Rate for Payer: Zelis Worker's Compensation |
$66.07
|
|
|
PHYS/QHP TELEPHONE EVALUATION 21-30 MIN
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT 99443
|
| Hospital Charge Code |
7999443
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$33.50 |
| Max. Negotiated Rate |
$127.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna Commercial |
$113.90
|
| Rate for Payer: First Health Commercial |
$120.60
|
| Rate for Payer: First Health Workers Compensation |
$51.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$120.60
|
| Rate for Payer: GEHA Commercial |
$107.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$120.60
|
| Rate for Payer: Humana ChoiceCare |
$34.84
|
| Rate for Payer: Multiplan All |
$121.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$80.40
|
| Rate for Payer: OMNI Networks Commercial |
$93.80
|
| Rate for Payer: One Health Plan PPO/POS |
$120.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$127.30
|
| Rate for Payer: Three Rivers Provider Network All |
$100.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$117.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$33.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$124.62
|
| Rate for Payer: Zelis Auto |
$53.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$67.00
|
| Rate for Payer: Zelis Worker's Compensation |
$36.58
|
|
|
PHYS/QHP TELEPHONE EVALUATION 21-30 MIN
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 99443
|
| Hospital Charge Code |
21799443
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$60.50 |
| Max. Negotiated Rate |
$229.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$145.20
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$205.70
|
| Rate for Payer: First Health Commercial |
$217.80
|
| Rate for Payer: First Health Workers Compensation |
$93.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$217.80
|
| Rate for Payer: GEHA Commercial |
$193.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$217.80
|
| Rate for Payer: Humana ChoiceCare |
$62.92
|
| Rate for Payer: Multiplan All |
$220.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$145.20
|
| Rate for Payer: OMNI Networks Commercial |
$169.40
|
| Rate for Payer: One Health Plan PPO/POS |
$217.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$229.90
|
| Rate for Payer: Three Rivers Provider Network All |
$181.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$212.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$60.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$225.06
|
| Rate for Payer: Zelis Auto |
$96.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.00
|
| Rate for Payer: Zelis Worker's Compensation |
$66.07
|
|
|
PHYS/QHP TELEPHONE EVALUATION 21-30 MIN
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
CPT 99443
|
| Hospital Charge Code |
1900064
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$279.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$176.40
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna Commercial |
$249.90
|
| Rate for Payer: First Health Commercial |
$264.60
|
| Rate for Payer: First Health Workers Compensation |
$113.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$264.60
|
| Rate for Payer: GEHA Commercial |
$235.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$264.60
|
| Rate for Payer: Humana ChoiceCare |
$76.44
|
| Rate for Payer: Multiplan All |
$267.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$176.40
|
| Rate for Payer: OMNI Networks Commercial |
$205.80
|
| Rate for Payer: One Health Plan PPO/POS |
$264.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$279.30
|
| Rate for Payer: Three Rivers Provider Network All |
$220.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$258.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$73.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$273.42
|
| Rate for Payer: Zelis Auto |
$117.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$147.00
|
| Rate for Payer: Zelis Worker's Compensation |
$80.26
|
|
|
PHYS/QHP TELEPHONE EVALUATION 21-30 MIN
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 99443
|
| Hospital Charge Code |
21799443
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$66.07 |
| Max. Negotiated Rate |
$229.90 |
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$205.70
|
| Rate for Payer: First Health Commercial |
$217.80
|
| Rate for Payer: First Health Workers Compensation |
$93.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$217.80
|
| Rate for Payer: GEHA Commercial |
$169.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$217.80
|
| Rate for Payer: Multiplan All |
$220.22
|
| Rate for Payer: OMNI Networks Commercial |
$169.40
|
| Rate for Payer: One Health Plan PPO/POS |
$217.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$229.90
|
| Rate for Payer: Three Rivers Provider Network All |
$181.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$225.06
|
| Rate for Payer: Zelis Auto |
$96.80
|
| Rate for Payer: Zelis Worker's Compensation |
$66.07
|
|
|
PHYS/QHP TELEPHONE EVALUATION 21-30 MIN
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 99443
|
| Hospital Charge Code |
21099443
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$60.50 |
| Max. Negotiated Rate |
$229.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$145.20
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$205.70
|
| Rate for Payer: First Health Commercial |
$217.80
|
| Rate for Payer: First Health Workers Compensation |
$93.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$217.80
|
| Rate for Payer: GEHA Commercial |
$193.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$217.80
|
| Rate for Payer: Humana ChoiceCare |
$62.92
|
| Rate for Payer: Multiplan All |
$220.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$145.20
|
| Rate for Payer: OMNI Networks Commercial |
$169.40
|
| Rate for Payer: One Health Plan PPO/POS |
$217.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$229.90
|
| Rate for Payer: Three Rivers Provider Network All |
$181.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$212.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$60.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$225.06
|
| Rate for Payer: Zelis Auto |
$96.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.00
|
| Rate for Payer: Zelis Worker's Compensation |
$66.07
|
|
|
PHYS/QHP TELEPHONE EVALUATION 21-30 MIN
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT 99443
|
| Hospital Charge Code |
23599443
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$33.50 |
| Max. Negotiated Rate |
$127.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna Commercial |
$113.90
|
| Rate for Payer: First Health Commercial |
$120.60
|
| Rate for Payer: First Health Workers Compensation |
$51.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$120.60
|
| Rate for Payer: GEHA Commercial |
$107.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$120.60
|
| Rate for Payer: Humana ChoiceCare |
$34.84
|
| Rate for Payer: Multiplan All |
$121.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$80.40
|
| Rate for Payer: OMNI Networks Commercial |
$93.80
|
| Rate for Payer: One Health Plan PPO/POS |
$120.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$127.30
|
| Rate for Payer: Three Rivers Provider Network All |
$100.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$117.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$33.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$124.62
|
| Rate for Payer: Zelis Auto |
$53.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$67.00
|
| Rate for Payer: Zelis Worker's Compensation |
$36.58
|
|
|
PHYS/QHP TELEPHONE EVALUATION 21-30 MIN
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 99443
|
| Hospital Charge Code |
20399443
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$66.07 |
| Max. Negotiated Rate |
$229.90 |
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$205.70
|
| Rate for Payer: First Health Commercial |
$217.80
|
| Rate for Payer: First Health Workers Compensation |
$93.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$217.80
|
| Rate for Payer: GEHA Commercial |
$169.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$217.80
|
| Rate for Payer: Multiplan All |
$220.22
|
| Rate for Payer: OMNI Networks Commercial |
$169.40
|
| Rate for Payer: One Health Plan PPO/POS |
$217.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$229.90
|
| Rate for Payer: Three Rivers Provider Network All |
$181.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$225.06
|
| Rate for Payer: Zelis Auto |
$96.80
|
| Rate for Payer: Zelis Worker's Compensation |
$66.07
|
|
|
PHYS/QHP TELEPHONE EVALUATION 21-30 MIN
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 99443
|
| Hospital Charge Code |
23599443
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$36.58 |
| Max. Negotiated Rate |
$127.30 |
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna Commercial |
$113.90
|
| Rate for Payer: First Health Commercial |
$120.60
|
| Rate for Payer: First Health Workers Compensation |
$51.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$120.60
|
| Rate for Payer: GEHA Commercial |
$93.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$120.60
|
| Rate for Payer: Multiplan All |
$121.94
|
| Rate for Payer: OMNI Networks Commercial |
$93.80
|
| Rate for Payer: One Health Plan PPO/POS |
$120.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$127.30
|
| Rate for Payer: Three Rivers Provider Network All |
$100.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$124.62
|
| Rate for Payer: Zelis Auto |
$53.60
|
| Rate for Payer: Zelis Worker's Compensation |
$36.58
|
|
|
PHYS/QHP TELEPHONE EVALUATION 21-30 MIN
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 99443
|
| Hospital Charge Code |
8799443
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$36.58 |
| Max. Negotiated Rate |
$127.30 |
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna Commercial |
$113.90
|
| Rate for Payer: First Health Commercial |
$120.60
|
| Rate for Payer: First Health Workers Compensation |
$51.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$120.60
|
| Rate for Payer: GEHA Commercial |
$93.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$120.60
|
| Rate for Payer: Multiplan All |
$121.94
|
| Rate for Payer: OMNI Networks Commercial |
$93.80
|
| Rate for Payer: One Health Plan PPO/POS |
$120.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$127.30
|
| Rate for Payer: Three Rivers Provider Network All |
$100.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$124.62
|
| Rate for Payer: Zelis Auto |
$53.60
|
| Rate for Payer: Zelis Worker's Compensation |
$36.58
|
|
|
PHYS/QHP TELEPHONE EVALUATION 21-30 MIN
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 99443
|
| Hospital Charge Code |
20399443
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$60.50 |
| Max. Negotiated Rate |
$229.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$145.20
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$205.70
|
| Rate for Payer: First Health Commercial |
$217.80
|
| Rate for Payer: First Health Workers Compensation |
$93.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$217.80
|
| Rate for Payer: GEHA Commercial |
$193.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$217.80
|
| Rate for Payer: Humana ChoiceCare |
$62.92
|
| Rate for Payer: Multiplan All |
$220.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$145.20
|
| Rate for Payer: OMNI Networks Commercial |
$169.40
|
| Rate for Payer: One Health Plan PPO/POS |
$217.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$229.90
|
| Rate for Payer: Three Rivers Provider Network All |
$181.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$212.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$60.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$225.06
|
| Rate for Payer: Zelis Auto |
$96.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.00
|
| Rate for Payer: Zelis Worker's Compensation |
$66.07
|
|
|
PHYS/QHP TELEPHONE EVALUATION 21-30 MIN
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 99443
|
| Hospital Charge Code |
21599225
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$36.58 |
| Max. Negotiated Rate |
$127.30 |
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna Commercial |
$113.90
|
| Rate for Payer: First Health Commercial |
$120.60
|
| Rate for Payer: First Health Workers Compensation |
$51.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$120.60
|
| Rate for Payer: GEHA Commercial |
$93.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$120.60
|
| Rate for Payer: Multiplan All |
$121.94
|
| Rate for Payer: OMNI Networks Commercial |
$93.80
|
| Rate for Payer: One Health Plan PPO/POS |
$120.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$127.30
|
| Rate for Payer: Three Rivers Provider Network All |
$100.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$124.62
|
| Rate for Payer: Zelis Auto |
$53.60
|
| Rate for Payer: Zelis Worker's Compensation |
$36.58
|
|
