|
PHYS/QHP TELEPHONE EVALUATION 5-10 MIN
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT G2012
|
| Hospital Charge Code |
9499441
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$32.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$20.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$20.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$20.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$16.46
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cigna Commercial |
$28.90
|
| Rate for Payer: First Health Commercial |
$30.60
|
| Rate for Payer: First Health Workers Compensation |
$13.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$30.60
|
| Rate for Payer: GEHA Commercial |
$27.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$30.60
|
| Rate for Payer: Humana ChoiceCare |
$8.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$16.79
|
| Rate for Payer: Multiplan All |
$30.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20.40
|
| Rate for Payer: OMNI Networks Commercial |
$23.80
|
| Rate for Payer: One Health Plan PPO/POS |
$30.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$19.39
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$16.79
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$32.30
|
| Rate for Payer: Three Rivers Provider Network All |
$25.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$29.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16.79
|
| Rate for Payer: United Payors & United Providers UP&UP |
$31.62
|
| Rate for Payer: Zelis Auto |
$13.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$17.00
|
| Rate for Payer: Zelis Worker's Compensation |
$9.28
|
|
|
PHYS/QHP TELEPHONE EVALUATION 5-10 MIN
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
CPT 99441
|
| Hospital Charge Code |
21099441
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$21.57 |
| Max. Negotiated Rate |
$75.05 |
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$67.15
|
| Rate for Payer: First Health Commercial |
$71.10
|
| Rate for Payer: First Health Workers Compensation |
$30.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$71.10
|
| Rate for Payer: GEHA Commercial |
$55.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$71.10
|
| Rate for Payer: Multiplan All |
$71.89
|
| Rate for Payer: OMNI Networks Commercial |
$55.30
|
| Rate for Payer: One Health Plan PPO/POS |
$71.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$75.05
|
| Rate for Payer: Three Rivers Provider Network All |
$59.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$73.47
|
| Rate for Payer: Zelis Auto |
$31.60
|
| Rate for Payer: Zelis Worker's Compensation |
$21.57
|
|
|
PHYS/QHP TELEPHONE EVALUATION 5-10 MIN
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT G2012
|
| Hospital Charge Code |
8799441
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$32.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$20.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$20.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$20.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$16.46
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cigna Commercial |
$28.90
|
| Rate for Payer: First Health Commercial |
$30.60
|
| Rate for Payer: First Health Workers Compensation |
$13.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$30.60
|
| Rate for Payer: GEHA Commercial |
$27.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$30.60
|
| Rate for Payer: Humana ChoiceCare |
$8.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$16.79
|
| Rate for Payer: Multiplan All |
$30.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20.40
|
| Rate for Payer: OMNI Networks Commercial |
$23.80
|
| Rate for Payer: One Health Plan PPO/POS |
$30.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$19.39
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$16.79
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$32.30
|
| Rate for Payer: Three Rivers Provider Network All |
$25.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$29.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16.79
|
| Rate for Payer: United Payors & United Providers UP&UP |
$31.62
|
| Rate for Payer: Zelis Auto |
$13.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$17.00
|
| Rate for Payer: Zelis Worker's Compensation |
$9.28
|
|
|
PHYS/QHP TELEPHONE EVALUATION 5-10 MIN
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
CPT 99441
|
| Hospital Charge Code |
8499441
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$19.75 |
| Max. Negotiated Rate |
$75.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$47.40
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$67.15
|
| Rate for Payer: First Health Commercial |
$71.10
|
| Rate for Payer: First Health Workers Compensation |
$30.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$71.10
|
| Rate for Payer: GEHA Commercial |
$63.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$71.10
|
| Rate for Payer: Humana ChoiceCare |
$20.54
|
| Rate for Payer: Multiplan All |
$71.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$47.40
|
| Rate for Payer: OMNI Networks Commercial |
$55.30
|
| Rate for Payer: One Health Plan PPO/POS |
$71.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$75.05
|
| Rate for Payer: Three Rivers Provider Network All |
$59.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$69.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$19.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$73.47
|
| Rate for Payer: Zelis Auto |
$31.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$39.50
|
| Rate for Payer: Zelis Worker's Compensation |
$21.57
|
|
|
PHYS/QHP TELEPHONE EVALUATION 5-10 MIN
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
CPT 99441
|
| Hospital Charge Code |
1900062
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$29.48 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cigna Commercial |
$91.80
|
| Rate for Payer: First Health Commercial |
$97.20
|
| Rate for Payer: First Health Workers Compensation |
$41.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$97.20
|
| Rate for Payer: GEHA Commercial |
$75.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$97.20
|
| Rate for Payer: Multiplan All |
$98.28
|
| Rate for Payer: OMNI Networks Commercial |
$75.60
|
| Rate for Payer: One Health Plan PPO/POS |
$97.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$102.60
|
| Rate for Payer: Three Rivers Provider Network All |
$81.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$100.44
|
| Rate for Payer: Zelis Auto |
$43.20
|
| Rate for Payer: Zelis Worker's Compensation |
$29.48
|
|
|
PHYS/QHP TELEPHONE EVALUATION 5-10 MIN
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
CPT 99441
|
| Hospital Charge Code |
8499441
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$21.57 |
| Max. Negotiated Rate |
$75.05 |
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$67.15
|
| Rate for Payer: First Health Commercial |
$71.10
|
| Rate for Payer: First Health Workers Compensation |
$30.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$71.10
|
| Rate for Payer: GEHA Commercial |
$55.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$71.10
|
| Rate for Payer: Multiplan All |
$71.89
|
| Rate for Payer: OMNI Networks Commercial |
$55.30
|
| Rate for Payer: One Health Plan PPO/POS |
$71.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$75.05
|
| Rate for Payer: Three Rivers Provider Network All |
$59.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$73.47
|
| Rate for Payer: Zelis Auto |
$31.60
|
| Rate for Payer: Zelis Worker's Compensation |
$21.57
|
|
|
PHYS/QHP TELEPHONE EVALUATION 5-10 MIN
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
CPT 99441
|
| Hospital Charge Code |
9699441
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$19.75 |
| Max. Negotiated Rate |
$75.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$47.40
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$67.15
|
| Rate for Payer: First Health Commercial |
$71.10
|
| Rate for Payer: First Health Workers Compensation |
$30.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$71.10
|
| Rate for Payer: GEHA Commercial |
$63.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$71.10
|
| Rate for Payer: Humana ChoiceCare |
$20.54
|
| Rate for Payer: Multiplan All |
$71.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$47.40
|
| Rate for Payer: OMNI Networks Commercial |
$55.30
|
| Rate for Payer: One Health Plan PPO/POS |
$71.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$75.05
|
| Rate for Payer: Three Rivers Provider Network All |
$59.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$69.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$19.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$73.47
|
| Rate for Payer: Zelis Auto |
$31.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$39.50
|
| Rate for Payer: Zelis Worker's Compensation |
$21.57
|
|
|
PHYS/QHP TELEPHONE EVALUATION 5-10 MIN
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
CPT 99441
|
| Hospital Charge Code |
9699441
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$21.57 |
| Max. Negotiated Rate |
$75.05 |
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$67.15
|
| Rate for Payer: First Health Commercial |
$71.10
|
| Rate for Payer: First Health Workers Compensation |
$30.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$71.10
|
| Rate for Payer: GEHA Commercial |
$55.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$71.10
|
| Rate for Payer: Multiplan All |
$71.89
|
| Rate for Payer: OMNI Networks Commercial |
$55.30
|
| Rate for Payer: One Health Plan PPO/POS |
$71.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$75.05
|
| Rate for Payer: Three Rivers Provider Network All |
$59.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$73.47
|
| Rate for Payer: Zelis Auto |
$31.60
|
| Rate for Payer: Zelis Worker's Compensation |
$21.57
|
|
|
PHYS/QHP TELEPHONE EVALUATION 5-10 MIN
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
CPT G2012
|
| Hospital Charge Code |
9799441
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$9.28 |
| Max. Negotiated Rate |
$32.30 |
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cigna Commercial |
$28.90
|
| Rate for Payer: First Health Commercial |
$30.60
|
| Rate for Payer: First Health Workers Compensation |
$13.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$30.60
|
| Rate for Payer: GEHA Commercial |
$23.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$30.60
|
| Rate for Payer: Multiplan All |
$30.94
|
| Rate for Payer: OMNI Networks Commercial |
$23.80
|
| Rate for Payer: One Health Plan PPO/POS |
$30.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$32.30
|
| Rate for Payer: Three Rivers Provider Network All |
$25.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$31.62
|
| Rate for Payer: Zelis Auto |
$13.60
|
| Rate for Payer: Zelis Worker's Compensation |
$9.28
|
|
|
PHYS/QHP TELEPHONE EVALUATION 5-10 MIN
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
CPT 99441
|
| Hospital Charge Code |
20399441
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$19.75 |
| Max. Negotiated Rate |
$75.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$47.40
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$67.15
|
| Rate for Payer: First Health Commercial |
$71.10
|
| Rate for Payer: First Health Workers Compensation |
$30.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$71.10
|
| Rate for Payer: GEHA Commercial |
$63.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$71.10
|
| Rate for Payer: Humana ChoiceCare |
$20.54
|
| Rate for Payer: Multiplan All |
$71.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$47.40
|
| Rate for Payer: OMNI Networks Commercial |
$55.30
|
| Rate for Payer: One Health Plan PPO/POS |
$71.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$75.05
|
| Rate for Payer: Three Rivers Provider Network All |
$59.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$69.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$19.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$73.47
|
| Rate for Payer: Zelis Auto |
$31.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$39.50
|
| Rate for Payer: Zelis Worker's Compensation |
$21.57
|
|
|
PHYS/QHP TELEPHONE EVALUATION 5-10 MIN
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
CPT G2012
|
| Hospital Charge Code |
9499441
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$9.28 |
| Max. Negotiated Rate |
$32.30 |
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cigna Commercial |
$28.90
|
| Rate for Payer: First Health Commercial |
$30.60
|
| Rate for Payer: First Health Workers Compensation |
$13.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$30.60
|
| Rate for Payer: GEHA Commercial |
$23.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$30.60
|
| Rate for Payer: Multiplan All |
$30.94
|
| Rate for Payer: OMNI Networks Commercial |
$23.80
|
| Rate for Payer: One Health Plan PPO/POS |
$30.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$32.30
|
| Rate for Payer: Three Rivers Provider Network All |
$25.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$31.62
|
| Rate for Payer: Zelis Auto |
$13.60
|
| Rate for Payer: Zelis Worker's Compensation |
$9.28
|
|
|
PHYS/QHP TELEPHONE EVALUATION 5-10 MIN
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT G2012
|
| Hospital Charge Code |
9799441
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$32.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$20.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$20.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$20.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$16.46
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cigna Commercial |
$28.90
|
| Rate for Payer: First Health Commercial |
$30.60
|
| Rate for Payer: First Health Workers Compensation |
$13.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$30.60
|
| Rate for Payer: GEHA Commercial |
$27.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$30.60
|
| Rate for Payer: Humana ChoiceCare |
$8.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$16.79
|
| Rate for Payer: Multiplan All |
$30.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20.40
|
| Rate for Payer: OMNI Networks Commercial |
$23.80
|
| Rate for Payer: One Health Plan PPO/POS |
$30.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$19.39
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$16.79
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$32.30
|
| Rate for Payer: Three Rivers Provider Network All |
$25.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$29.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16.79
|
| Rate for Payer: United Payors & United Providers UP&UP |
$31.62
|
| Rate for Payer: Zelis Auto |
$13.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$17.00
|
| Rate for Payer: Zelis Worker's Compensation |
$9.28
|
|
|
PHYS/QHP TELEPHONE EVALUATION 5-10 MIN
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
CPT 99441
|
| Hospital Charge Code |
20399441
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$21.57 |
| Max. Negotiated Rate |
$75.05 |
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$67.15
|
| Rate for Payer: First Health Commercial |
$71.10
|
| Rate for Payer: First Health Workers Compensation |
$30.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$71.10
|
| Rate for Payer: GEHA Commercial |
$55.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$71.10
|
| Rate for Payer: Multiplan All |
$71.89
|
| Rate for Payer: OMNI Networks Commercial |
$55.30
|
| Rate for Payer: One Health Plan PPO/POS |
$71.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$75.05
|
| Rate for Payer: Three Rivers Provider Network All |
$59.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$73.47
|
| Rate for Payer: Zelis Auto |
$31.60
|
| Rate for Payer: Zelis Worker's Compensation |
$21.57
|
|
|
PHYS/QHP TELEPHONE EVALUATION 5-10 MIN
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
CPT G2012
|
| Hospital Charge Code |
8399441
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$9.28 |
| Max. Negotiated Rate |
$32.30 |
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cigna Commercial |
$28.90
|
| Rate for Payer: First Health Commercial |
$30.60
|
| Rate for Payer: First Health Workers Compensation |
$13.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$30.60
|
| Rate for Payer: GEHA Commercial |
$23.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$30.60
|
| Rate for Payer: Multiplan All |
$30.94
|
| Rate for Payer: OMNI Networks Commercial |
$23.80
|
| Rate for Payer: One Health Plan PPO/POS |
$30.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$32.30
|
| Rate for Payer: Three Rivers Provider Network All |
$25.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$31.62
|
| Rate for Payer: Zelis Auto |
$13.60
|
| Rate for Payer: Zelis Worker's Compensation |
$9.28
|
|
|
PHYS/QHP TELEPHONE EVALUATION 5-10 MIN
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
CPT 99441
|
| Hospital Charge Code |
7600015
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$19.75 |
| Max. Negotiated Rate |
$75.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$47.40
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$67.15
|
| Rate for Payer: First Health Commercial |
$71.10
|
| Rate for Payer: First Health Workers Compensation |
$30.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$71.10
|
| Rate for Payer: GEHA Commercial |
$63.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$71.10
|
| Rate for Payer: Humana ChoiceCare |
$20.54
|
| Rate for Payer: Multiplan All |
$71.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$47.40
|
| Rate for Payer: OMNI Networks Commercial |
$55.30
|
| Rate for Payer: One Health Plan PPO/POS |
$71.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$75.05
|
| Rate for Payer: Three Rivers Provider Network All |
$59.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$69.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$19.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$73.47
|
| Rate for Payer: Zelis Auto |
$31.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$39.50
|
| Rate for Payer: Zelis Worker's Compensation |
$21.57
|
|
|
PHYS/QHP TELEPHONE EVALUATION 5-10 MIN
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
CPT 99441
|
| Hospital Charge Code |
8299441
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$19.75 |
| Max. Negotiated Rate |
$75.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$47.40
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$67.15
|
| Rate for Payer: First Health Commercial |
$71.10
|
| Rate for Payer: First Health Workers Compensation |
$30.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$71.10
|
| Rate for Payer: GEHA Commercial |
$63.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$71.10
|
| Rate for Payer: Humana ChoiceCare |
$20.54
|
| Rate for Payer: Multiplan All |
$71.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$47.40
|
| Rate for Payer: OMNI Networks Commercial |
$55.30
|
| Rate for Payer: One Health Plan PPO/POS |
$71.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$75.05
|
| Rate for Payer: Three Rivers Provider Network All |
$59.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$69.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$19.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$73.47
|
| Rate for Payer: Zelis Auto |
$31.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$39.50
|
| Rate for Payer: Zelis Worker's Compensation |
$21.57
|
|
|
PHYS/QHP TELEPHONE EVALUATION 5-10 MIN
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
CPT 99441
|
| Hospital Charge Code |
21799441
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$19.75 |
| Max. Negotiated Rate |
$75.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$47.40
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$67.15
|
| Rate for Payer: First Health Commercial |
$71.10
|
| Rate for Payer: First Health Workers Compensation |
$30.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$71.10
|
| Rate for Payer: GEHA Commercial |
$63.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$71.10
|
| Rate for Payer: Humana ChoiceCare |
$20.54
|
| Rate for Payer: Multiplan All |
$71.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$47.40
|
| Rate for Payer: OMNI Networks Commercial |
$55.30
|
| Rate for Payer: One Health Plan PPO/POS |
$71.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$75.05
|
| Rate for Payer: Three Rivers Provider Network All |
$59.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$69.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$19.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$73.47
|
| Rate for Payer: Zelis Auto |
$31.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$39.50
|
| Rate for Payer: Zelis Worker's Compensation |
$21.57
|
|
|
PHYS/QHP TELEPHONE EVALUATION 5-10 MIN
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
CPT 99441
|
| Hospital Charge Code |
24799441
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$19.75 |
| Max. Negotiated Rate |
$75.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$47.40
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$67.15
|
| Rate for Payer: First Health Commercial |
$71.10
|
| Rate for Payer: First Health Workers Compensation |
$30.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$71.10
|
| Rate for Payer: GEHA Commercial |
$63.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$71.10
|
| Rate for Payer: Humana ChoiceCare |
$20.54
|
| Rate for Payer: Multiplan All |
$71.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$47.40
|
| Rate for Payer: OMNI Networks Commercial |
$55.30
|
| Rate for Payer: One Health Plan PPO/POS |
$71.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$75.05
|
| Rate for Payer: Three Rivers Provider Network All |
$59.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$69.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$19.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$73.47
|
| Rate for Payer: Zelis Auto |
$31.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$39.50
|
| Rate for Payer: Zelis Worker's Compensation |
$21.57
|
|
|
PHYS/QHP TELEPHONE EVALUATION 5-10 MIN
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
CPT 99441
|
| Hospital Charge Code |
24799441
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$21.57 |
| Max. Negotiated Rate |
$75.05 |
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$67.15
|
| Rate for Payer: First Health Commercial |
$71.10
|
| Rate for Payer: First Health Workers Compensation |
$30.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$71.10
|
| Rate for Payer: GEHA Commercial |
$55.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$71.10
|
| Rate for Payer: Multiplan All |
$71.89
|
| Rate for Payer: OMNI Networks Commercial |
$55.30
|
| Rate for Payer: One Health Plan PPO/POS |
$71.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$75.05
|
| Rate for Payer: Three Rivers Provider Network All |
$59.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$73.47
|
| Rate for Payer: Zelis Auto |
$31.60
|
| Rate for Payer: Zelis Worker's Compensation |
$21.57
|
|
|
PHYS/QHP TELEPHONE EVALUATION 5-10 MIN
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
CPT 99441
|
| Hospital Charge Code |
24599441
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$21.57 |
| Max. Negotiated Rate |
$75.05 |
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$67.15
|
| Rate for Payer: First Health Commercial |
$71.10
|
| Rate for Payer: First Health Workers Compensation |
$30.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$71.10
|
| Rate for Payer: GEHA Commercial |
$55.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$71.10
|
| Rate for Payer: Multiplan All |
$71.89
|
| Rate for Payer: OMNI Networks Commercial |
$55.30
|
| Rate for Payer: One Health Plan PPO/POS |
$71.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$75.05
|
| Rate for Payer: Three Rivers Provider Network All |
$59.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$73.47
|
| Rate for Payer: Zelis Auto |
$31.60
|
| Rate for Payer: Zelis Worker's Compensation |
$21.57
|
|
|
PHYS/QHP TELEPHONE EVALUATION 5-10 MIN
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
CPT 99441
|
| Hospital Charge Code |
24599441
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$19.75 |
| Max. Negotiated Rate |
$75.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$47.40
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$67.15
|
| Rate for Payer: First Health Commercial |
$71.10
|
| Rate for Payer: First Health Workers Compensation |
$30.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$71.10
|
| Rate for Payer: GEHA Commercial |
$63.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$71.10
|
| Rate for Payer: Humana ChoiceCare |
$20.54
|
| Rate for Payer: Multiplan All |
$71.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$47.40
|
| Rate for Payer: OMNI Networks Commercial |
$55.30
|
| Rate for Payer: One Health Plan PPO/POS |
$71.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$75.05
|
| Rate for Payer: Three Rivers Provider Network All |
$59.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$69.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$19.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$73.47
|
| Rate for Payer: Zelis Auto |
$31.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$39.50
|
| Rate for Payer: Zelis Worker's Compensation |
$21.57
|
|
|
PHYS/QHP TELEPHONE EVALUATION 5-10 MIN
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 99441
|
| Hospital Charge Code |
7999441
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$8.50 |
| Max. Negotiated Rate |
$32.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cigna Commercial |
$28.90
|
| Rate for Payer: First Health Commercial |
$30.60
|
| Rate for Payer: First Health Workers Compensation |
$13.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$30.60
|
| Rate for Payer: GEHA Commercial |
$27.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$30.60
|
| Rate for Payer: Humana ChoiceCare |
$8.84
|
| Rate for Payer: Multiplan All |
$30.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20.40
|
| Rate for Payer: OMNI Networks Commercial |
$23.80
|
| Rate for Payer: One Health Plan PPO/POS |
$30.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$32.30
|
| Rate for Payer: Three Rivers Provider Network All |
$25.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$29.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$31.62
|
| Rate for Payer: Zelis Auto |
$13.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$17.00
|
| Rate for Payer: Zelis Worker's Compensation |
$9.28
|
|
|
PHYS/QHP TELEPHONE EVALUATION 5-10 MIN
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT G2012
|
| Hospital Charge Code |
25599441
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$32.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$20.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$20.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$20.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$16.46
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cigna Commercial |
$28.90
|
| Rate for Payer: First Health Commercial |
$30.60
|
| Rate for Payer: First Health Workers Compensation |
$13.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$30.60
|
| Rate for Payer: GEHA Commercial |
$27.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$30.60
|
| Rate for Payer: Humana ChoiceCare |
$8.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$16.79
|
| Rate for Payer: Multiplan All |
$30.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20.40
|
| Rate for Payer: OMNI Networks Commercial |
$23.80
|
| Rate for Payer: One Health Plan PPO/POS |
$30.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$19.39
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$16.79
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$32.30
|
| Rate for Payer: Three Rivers Provider Network All |
$25.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$29.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16.79
|
| Rate for Payer: United Payors & United Providers UP&UP |
$31.62
|
| Rate for Payer: Zelis Auto |
$13.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$17.00
|
| Rate for Payer: Zelis Worker's Compensation |
$9.28
|
|
|
PHYS/QHP TELEPHONE EVALUATION 5-10 MIN
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
CPT 99441
|
| Hospital Charge Code |
21900176
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$19.75 |
| Max. Negotiated Rate |
$75.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$47.40
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$67.15
|
| Rate for Payer: First Health Commercial |
$71.10
|
| Rate for Payer: First Health Workers Compensation |
$30.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$71.10
|
| Rate for Payer: GEHA Commercial |
$63.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$71.10
|
| Rate for Payer: Humana ChoiceCare |
$20.54
|
| Rate for Payer: Multiplan All |
$71.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$47.40
|
| Rate for Payer: OMNI Networks Commercial |
$55.30
|
| Rate for Payer: One Health Plan PPO/POS |
$71.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$75.05
|
| Rate for Payer: Three Rivers Provider Network All |
$59.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$69.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$19.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$73.47
|
| Rate for Payer: Zelis Auto |
$31.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$39.50
|
| Rate for Payer: Zelis Worker's Compensation |
$21.57
|
|
|
PHYS/QHP TELEPHONE EVALUATION 5-10 MIN
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
CPT 99441
|
| Hospital Charge Code |
23599441
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.28 |
| Max. Negotiated Rate |
$32.30 |
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cigna Commercial |
$28.90
|
| Rate for Payer: First Health Commercial |
$30.60
|
| Rate for Payer: First Health Workers Compensation |
$13.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$30.60
|
| Rate for Payer: GEHA Commercial |
$23.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$30.60
|
| Rate for Payer: Multiplan All |
$30.94
|
| Rate for Payer: OMNI Networks Commercial |
$23.80
|
| Rate for Payer: One Health Plan PPO/POS |
$30.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$32.30
|
| Rate for Payer: Three Rivers Provider Network All |
$25.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$31.62
|
| Rate for Payer: Zelis Auto |
$13.60
|
| Rate for Payer: Zelis Worker's Compensation |
$9.28
|
|
