|
99080 SPECIAL REPORTS OR FORMS
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 99080
|
| Hospital Charge Code |
21900174
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$23.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$21.25
|
| Rate for Payer: First Health Commercial |
$22.50
|
| Rate for Payer: First Health Workers Compensation |
$9.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$22.50
|
| Rate for Payer: GEHA Commercial |
$20.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$22.50
|
| Rate for Payer: Humana ChoiceCare |
$6.50
|
| Rate for Payer: Multiplan All |
$22.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$15.00
|
| Rate for Payer: OMNI Networks Commercial |
$17.50
|
| Rate for Payer: One Health Plan PPO/POS |
$22.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$23.75
|
| Rate for Payer: Three Rivers Provider Network All |
$18.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$22.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$6.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$23.25
|
| Rate for Payer: Zelis Auto |
$10.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$12.50
|
| Rate for Payer: Zelis Worker's Compensation |
$6.83
|
|
|
99080 SPECIAL REPORTS OR FORMS
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 99080
|
| Hospital Charge Code |
21900174
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$6.83 |
| Max. Negotiated Rate |
$23.75 |
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$21.25
|
| Rate for Payer: First Health Commercial |
$22.50
|
| Rate for Payer: First Health Workers Compensation |
$9.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$22.50
|
| Rate for Payer: GEHA Commercial |
$17.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$22.50
|
| Rate for Payer: Multiplan All |
$22.75
|
| Rate for Payer: OMNI Networks Commercial |
$17.50
|
| Rate for Payer: One Health Plan PPO/POS |
$22.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$23.75
|
| Rate for Payer: Three Rivers Provider Network All |
$18.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$23.25
|
| Rate for Payer: Zelis Auto |
$10.00
|
| Rate for Payer: Zelis Worker's Compensation |
$6.83
|
|
|
99080 SPECIAL REPORTS OR FORMS
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 99080
|
| Hospital Charge Code |
21799080
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$6.83 |
| Max. Negotiated Rate |
$23.75 |
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$21.25
|
| Rate for Payer: First Health Commercial |
$22.50
|
| Rate for Payer: First Health Workers Compensation |
$9.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$22.50
|
| Rate for Payer: GEHA Commercial |
$17.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$22.50
|
| Rate for Payer: Multiplan All |
$22.75
|
| Rate for Payer: OMNI Networks Commercial |
$17.50
|
| Rate for Payer: One Health Plan PPO/POS |
$22.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$23.75
|
| Rate for Payer: Three Rivers Provider Network All |
$18.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$23.25
|
| Rate for Payer: Zelis Auto |
$10.00
|
| Rate for Payer: Zelis Worker's Compensation |
$6.83
|
|
|
99201 OFFICE OUTPATIENT NEW 10 MINUTES
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 99201
|
| Hospital Charge Code |
24500024
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$115.60
|
| Rate for Payer: First Health Commercial |
$122.40
|
| Rate for Payer: First Health Workers Compensation |
$52.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$122.40
|
| Rate for Payer: GEHA Commercial |
$108.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$122.40
|
| Rate for Payer: Humana ChoiceCare |
$35.36
|
| Rate for Payer: Multiplan All |
$123.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$81.60
|
| Rate for Payer: OMNI Networks Commercial |
$95.20
|
| Rate for Payer: One Health Plan PPO/POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$129.20
|
| Rate for Payer: Three Rivers Provider Network All |
$102.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$34.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$126.48
|
| Rate for Payer: Zelis Auto |
$54.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$68.00
|
| Rate for Payer: Zelis Worker's Compensation |
$37.13
|
|
|
99201 OFFICE OUTPATIENT NEW 10 MINUTES
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 99201
|
| Hospital Charge Code |
21799201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$115.60
|
| Rate for Payer: First Health Commercial |
$122.40
|
| Rate for Payer: First Health Workers Compensation |
$52.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$122.40
|
| Rate for Payer: GEHA Commercial |
$108.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$122.40
|
| Rate for Payer: Humana ChoiceCare |
$35.36
|
| Rate for Payer: Multiplan All |
$123.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$81.60
|
| Rate for Payer: OMNI Networks Commercial |
$95.20
|
| Rate for Payer: One Health Plan PPO/POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$129.20
|
| Rate for Payer: Three Rivers Provider Network All |
$102.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$34.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$126.48
|
| Rate for Payer: Zelis Auto |
$54.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$68.00
|
| Rate for Payer: Zelis Worker's Compensation |
$37.13
|
|
|
99201 OFFICE OUTPATIENT NEW 10 MINUTES
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT 99201
|
| Hospital Charge Code |
21999201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$37.13 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$115.60
|
| Rate for Payer: First Health Commercial |
$122.40
|
| Rate for Payer: First Health Workers Compensation |
$52.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$122.40
|
| Rate for Payer: GEHA Commercial |
$95.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$122.40
|
| Rate for Payer: Multiplan All |
$123.76
|
| Rate for Payer: OMNI Networks Commercial |
$95.20
|
| Rate for Payer: One Health Plan PPO/POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$129.20
|
| Rate for Payer: Three Rivers Provider Network All |
$102.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$126.48
|
| Rate for Payer: Zelis Auto |
$54.40
|
| Rate for Payer: Zelis Worker's Compensation |
$37.13
|
|
|
99201 OFFICE OUTPATIENT NEW 10 MINUTES
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT 99201
|
| Hospital Charge Code |
21799201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$37.13 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$115.60
|
| Rate for Payer: First Health Commercial |
$122.40
|
| Rate for Payer: First Health Workers Compensation |
$52.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$122.40
|
| Rate for Payer: GEHA Commercial |
$95.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$122.40
|
| Rate for Payer: Multiplan All |
$123.76
|
| Rate for Payer: OMNI Networks Commercial |
$95.20
|
| Rate for Payer: One Health Plan PPO/POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$129.20
|
| Rate for Payer: Three Rivers Provider Network All |
$102.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$126.48
|
| Rate for Payer: Zelis Auto |
$54.40
|
| Rate for Payer: Zelis Worker's Compensation |
$37.13
|
|
|
99201 OFFICE OUTPATIENT NEW 10 MINUTES
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT 99201
|
| Hospital Charge Code |
21599201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$37.13 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$115.60
|
| Rate for Payer: First Health Commercial |
$122.40
|
| Rate for Payer: First Health Workers Compensation |
$52.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$122.40
|
| Rate for Payer: GEHA Commercial |
$95.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$122.40
|
| Rate for Payer: Multiplan All |
$123.76
|
| Rate for Payer: OMNI Networks Commercial |
$95.20
|
| Rate for Payer: One Health Plan PPO/POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$129.20
|
| Rate for Payer: Three Rivers Provider Network All |
$102.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$126.48
|
| Rate for Payer: Zelis Auto |
$54.40
|
| Rate for Payer: Zelis Worker's Compensation |
$37.13
|
|
|
99201 OFFICE OUTPATIENT NEW 10 MINUTES
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 99201
|
| Hospital Charge Code |
21599201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$115.60
|
| Rate for Payer: First Health Commercial |
$122.40
|
| Rate for Payer: First Health Workers Compensation |
$52.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$122.40
|
| Rate for Payer: GEHA Commercial |
$108.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$122.40
|
| Rate for Payer: Humana ChoiceCare |
$35.36
|
| Rate for Payer: Multiplan All |
$123.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$81.60
|
| Rate for Payer: OMNI Networks Commercial |
$95.20
|
| Rate for Payer: One Health Plan PPO/POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$129.20
|
| Rate for Payer: Three Rivers Provider Network All |
$102.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$34.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$126.48
|
| Rate for Payer: Zelis Auto |
$54.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$68.00
|
| Rate for Payer: Zelis Worker's Compensation |
$37.13
|
|
|
99201 OFFICE OUTPATIENT NEW 10 MINUTES
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT 99201
|
| Hospital Charge Code |
21600049
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$37.13 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$115.60
|
| Rate for Payer: First Health Commercial |
$122.40
|
| Rate for Payer: First Health Workers Compensation |
$52.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$122.40
|
| Rate for Payer: GEHA Commercial |
$95.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$122.40
|
| Rate for Payer: Multiplan All |
$123.76
|
| Rate for Payer: OMNI Networks Commercial |
$95.20
|
| Rate for Payer: One Health Plan PPO/POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$129.20
|
| Rate for Payer: Three Rivers Provider Network All |
$102.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$126.48
|
| Rate for Payer: Zelis Auto |
$54.40
|
| Rate for Payer: Zelis Worker's Compensation |
$37.13
|
|
|
99201 OFFICE OUTPATIENT NEW 10 MINUTES
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 99201
|
| Hospital Charge Code |
21600049
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$115.60
|
| Rate for Payer: First Health Commercial |
$122.40
|
| Rate for Payer: First Health Workers Compensation |
$52.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$122.40
|
| Rate for Payer: GEHA Commercial |
$108.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$122.40
|
| Rate for Payer: Humana ChoiceCare |
$35.36
|
| Rate for Payer: Multiplan All |
$123.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$81.60
|
| Rate for Payer: OMNI Networks Commercial |
$95.20
|
| Rate for Payer: One Health Plan PPO/POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$129.20
|
| Rate for Payer: Three Rivers Provider Network All |
$102.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$34.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$126.48
|
| Rate for Payer: Zelis Auto |
$54.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$68.00
|
| Rate for Payer: Zelis Worker's Compensation |
$37.13
|
|
|
99201 OFFICE OUTPATIENT NEW 10 MINUTES
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT 99201
|
| Hospital Charge Code |
24700024
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$37.13 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$115.60
|
| Rate for Payer: First Health Commercial |
$122.40
|
| Rate for Payer: First Health Workers Compensation |
$52.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$122.40
|
| Rate for Payer: GEHA Commercial |
$95.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$122.40
|
| Rate for Payer: Multiplan All |
$123.76
|
| Rate for Payer: OMNI Networks Commercial |
$95.20
|
| Rate for Payer: One Health Plan PPO/POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$129.20
|
| Rate for Payer: Three Rivers Provider Network All |
$102.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$126.48
|
| Rate for Payer: Zelis Auto |
$54.40
|
| Rate for Payer: Zelis Worker's Compensation |
$37.13
|
|
|
99201 OFFICE OUTPATIENT NEW 10 MINUTES
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 99201
|
| Hospital Charge Code |
21999201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$115.60
|
| Rate for Payer: First Health Commercial |
$122.40
|
| Rate for Payer: First Health Workers Compensation |
$52.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$122.40
|
| Rate for Payer: GEHA Commercial |
$108.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$122.40
|
| Rate for Payer: Humana ChoiceCare |
$35.36
|
| Rate for Payer: Multiplan All |
$123.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$81.60
|
| Rate for Payer: OMNI Networks Commercial |
$95.20
|
| Rate for Payer: One Health Plan PPO/POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$129.20
|
| Rate for Payer: Three Rivers Provider Network All |
$102.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$34.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$126.48
|
| Rate for Payer: Zelis Auto |
$54.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$68.00
|
| Rate for Payer: Zelis Worker's Compensation |
$37.13
|
|
|
99201 OFFICE OUTPATIENT NEW 10 MINUTES
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 99201
|
| Hospital Charge Code |
24700024
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$115.60
|
| Rate for Payer: First Health Commercial |
$122.40
|
| Rate for Payer: First Health Workers Compensation |
$52.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$122.40
|
| Rate for Payer: GEHA Commercial |
$108.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$122.40
|
| Rate for Payer: Humana ChoiceCare |
$35.36
|
| Rate for Payer: Multiplan All |
$123.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$81.60
|
| Rate for Payer: OMNI Networks Commercial |
$95.20
|
| Rate for Payer: One Health Plan PPO/POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$129.20
|
| Rate for Payer: Three Rivers Provider Network All |
$102.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$34.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$126.48
|
| Rate for Payer: Zelis Auto |
$54.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$68.00
|
| Rate for Payer: Zelis Worker's Compensation |
$37.13
|
|
|
99201 OFFICE OUTPATIENT NEW 10 MINUTES
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 99201
|
| Hospital Charge Code |
25500049
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$115.60
|
| Rate for Payer: First Health Commercial |
$122.40
|
| Rate for Payer: First Health Workers Compensation |
$52.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$122.40
|
| Rate for Payer: GEHA Commercial |
$108.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$122.40
|
| Rate for Payer: Humana ChoiceCare |
$35.36
|
| Rate for Payer: Multiplan All |
$123.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$81.60
|
| Rate for Payer: OMNI Networks Commercial |
$95.20
|
| Rate for Payer: One Health Plan PPO/POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$129.20
|
| Rate for Payer: Three Rivers Provider Network All |
$102.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$34.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$126.48
|
| Rate for Payer: Zelis Auto |
$54.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$68.00
|
| Rate for Payer: Zelis Worker's Compensation |
$37.13
|
|
|
99201 OFFICE OUTPATIENT NEW 10 MINUTES
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT 99201
|
| Hospital Charge Code |
24500024
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$37.13 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$115.60
|
| Rate for Payer: First Health Commercial |
$122.40
|
| Rate for Payer: First Health Workers Compensation |
$52.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$122.40
|
| Rate for Payer: GEHA Commercial |
$95.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$122.40
|
| Rate for Payer: Multiplan All |
$123.76
|
| Rate for Payer: OMNI Networks Commercial |
$95.20
|
| Rate for Payer: One Health Plan PPO/POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$129.20
|
| Rate for Payer: Three Rivers Provider Network All |
$102.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$126.48
|
| Rate for Payer: Zelis Auto |
$54.40
|
| Rate for Payer: Zelis Worker's Compensation |
$37.13
|
|
|
99201 OFFICE OUTPATIENT NEW 10 MINUTES
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT 99201
|
| Hospital Charge Code |
25500049
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$37.13 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$115.60
|
| Rate for Payer: First Health Commercial |
$122.40
|
| Rate for Payer: First Health Workers Compensation |
$52.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$122.40
|
| Rate for Payer: GEHA Commercial |
$95.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$122.40
|
| Rate for Payer: Multiplan All |
$123.76
|
| Rate for Payer: OMNI Networks Commercial |
$95.20
|
| Rate for Payer: One Health Plan PPO/POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$129.20
|
| Rate for Payer: Three Rivers Provider Network All |
$102.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$126.48
|
| Rate for Payer: Zelis Auto |
$54.40
|
| Rate for Payer: Zelis Worker's Compensation |
$37.13
|
|
|
99201 OFFICE VISIT LEVEL 1 LOW COMP
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 99201
|
| Hospital Charge Code |
7699201
|
|
Hospital Revenue Code
|
511
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$115.60
|
| Rate for Payer: First Health Commercial |
$122.40
|
| Rate for Payer: First Health Workers Compensation |
$52.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$122.40
|
| Rate for Payer: GEHA Commercial |
$108.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$122.40
|
| Rate for Payer: Humana ChoiceCare |
$35.36
|
| Rate for Payer: Multiplan All |
$123.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$81.60
|
| Rate for Payer: OMNI Networks Commercial |
$95.20
|
| Rate for Payer: One Health Plan PPO/POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$129.20
|
| Rate for Payer: Three Rivers Provider Network All |
$102.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$34.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$126.48
|
| Rate for Payer: Zelis Auto |
$54.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$68.00
|
| Rate for Payer: Zelis Worker's Compensation |
$37.13
|
|
|
99201 OFFICE VISIT LEVEL 1 LOW COMP
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT 99201
|
| Hospital Charge Code |
7599201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$37.13 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$115.60
|
| Rate for Payer: First Health Commercial |
$122.40
|
| Rate for Payer: First Health Workers Compensation |
$52.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$122.40
|
| Rate for Payer: GEHA Commercial |
$95.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$122.40
|
| Rate for Payer: Multiplan All |
$123.76
|
| Rate for Payer: OMNI Networks Commercial |
$95.20
|
| Rate for Payer: One Health Plan PPO/POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$129.20
|
| Rate for Payer: Three Rivers Provider Network All |
$102.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$126.48
|
| Rate for Payer: Zelis Auto |
$54.40
|
| Rate for Payer: Zelis Worker's Compensation |
$37.13
|
|
|
99201 OFFICE VISIT LEVEL 1 LOW COMP
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 99201
|
| Hospital Charge Code |
9299201
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$115.60
|
| Rate for Payer: First Health Commercial |
$122.40
|
| Rate for Payer: First Health Workers Compensation |
$52.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$122.40
|
| Rate for Payer: GEHA Commercial |
$108.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$122.40
|
| Rate for Payer: Humana ChoiceCare |
$35.36
|
| Rate for Payer: Multiplan All |
$123.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$81.60
|
| Rate for Payer: OMNI Networks Commercial |
$95.20
|
| Rate for Payer: One Health Plan PPO/POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$129.20
|
| Rate for Payer: Three Rivers Provider Network All |
$102.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$34.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$126.48
|
| Rate for Payer: Zelis Auto |
$54.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$68.00
|
| Rate for Payer: Zelis Worker's Compensation |
$37.13
|
|
|
99201 OFFICE VISIT LEVEL 1 LOW COMP
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT 99201
|
| Hospital Charge Code |
8299201
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$37.13 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$115.60
|
| Rate for Payer: First Health Commercial |
$122.40
|
| Rate for Payer: First Health Workers Compensation |
$52.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$122.40
|
| Rate for Payer: GEHA Commercial |
$95.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$122.40
|
| Rate for Payer: Multiplan All |
$123.76
|
| Rate for Payer: OMNI Networks Commercial |
$95.20
|
| Rate for Payer: One Health Plan PPO/POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$129.20
|
| Rate for Payer: Three Rivers Provider Network All |
$102.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$126.48
|
| Rate for Payer: Zelis Auto |
$54.40
|
| Rate for Payer: Zelis Worker's Compensation |
$37.13
|
|
|
99201 OFFICE VISIT LEVEL 1 LOW COMP
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT 99201
|
| Hospital Charge Code |
9799201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$37.13 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: First Health Commercial |
$122.40
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$115.60
|
| Rate for Payer: First Health Workers Compensation |
$52.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$122.40
|
| Rate for Payer: GEHA Commercial |
$95.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$122.40
|
| Rate for Payer: Multiplan All |
$123.76
|
| Rate for Payer: OMNI Networks Commercial |
$95.20
|
| Rate for Payer: One Health Plan PPO/POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$129.20
|
| Rate for Payer: Three Rivers Provider Network All |
$102.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$126.48
|
| Rate for Payer: Zelis Auto |
$54.40
|
| Rate for Payer: Zelis Worker's Compensation |
$37.13
|
|
|
99201 OFFICE VISIT LEVEL 1 LOW COMP
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT 99201
|
| Hospital Charge Code |
23500025
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$37.13 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$115.60
|
| Rate for Payer: First Health Commercial |
$122.40
|
| Rate for Payer: First Health Workers Compensation |
$52.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$122.40
|
| Rate for Payer: GEHA Commercial |
$95.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$122.40
|
| Rate for Payer: Multiplan All |
$123.76
|
| Rate for Payer: OMNI Networks Commercial |
$95.20
|
| Rate for Payer: One Health Plan PPO/POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$129.20
|
| Rate for Payer: Three Rivers Provider Network All |
$102.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$126.48
|
| Rate for Payer: Zelis Auto |
$54.40
|
| Rate for Payer: Zelis Worker's Compensation |
$37.13
|
|
|
99201 OFFICE VISIT LEVEL 1 LOW COMP
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT 99201
|
| Hospital Charge Code |
9099201
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$37.13 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$115.60
|
| Rate for Payer: First Health Commercial |
$122.40
|
| Rate for Payer: First Health Workers Compensation |
$52.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$122.40
|
| Rate for Payer: GEHA Commercial |
$95.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$122.40
|
| Rate for Payer: Multiplan All |
$123.76
|
| Rate for Payer: OMNI Networks Commercial |
$95.20
|
| Rate for Payer: One Health Plan PPO/POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$129.20
|
| Rate for Payer: Three Rivers Provider Network All |
$102.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$126.48
|
| Rate for Payer: Zelis Auto |
$54.40
|
| Rate for Payer: Zelis Worker's Compensation |
$37.13
|
|
|
99201 OFFICE VISIT LEVEL 1 LOW COMP
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT 99201
|
| Hospital Charge Code |
9699201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$37.13 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$115.60
|
| Rate for Payer: First Health Commercial |
$122.40
|
| Rate for Payer: First Health Workers Compensation |
$52.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$122.40
|
| Rate for Payer: GEHA Commercial |
$95.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$122.40
|
| Rate for Payer: Multiplan All |
$123.76
|
| Rate for Payer: OMNI Networks Commercial |
$95.20
|
| Rate for Payer: One Health Plan PPO/POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$129.20
|
| Rate for Payer: Three Rivers Provider Network All |
$102.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$126.48
|
| Rate for Payer: Zelis Auto |
$54.40
|
| Rate for Payer: Zelis Worker's Compensation |
$37.13
|
|
