|
99205 NEW PT HIGH MDM AT LEAST 60 MINS
|
Facility
|
OP
|
$641.00
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
7999205
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$160.25 |
| Max. Negotiated Rate |
$608.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$384.60
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cigna Commercial |
$544.85
|
| Rate for Payer: First Health Commercial |
$576.90
|
| Rate for Payer: First Health Workers Compensation |
$247.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$576.90
|
| Rate for Payer: GEHA Commercial |
$512.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$576.90
|
| Rate for Payer: Humana ChoiceCare |
$166.66
|
| Rate for Payer: Multiplan All |
$583.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$384.60
|
| Rate for Payer: OMNI Networks Commercial |
$448.70
|
| Rate for Payer: One Health Plan PPO/POS |
$576.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$608.95
|
| Rate for Payer: Three Rivers Provider Network All |
$480.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$564.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$160.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$596.13
|
| Rate for Payer: Zelis Auto |
$256.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$320.50
|
| Rate for Payer: Zelis Worker's Compensation |
$174.99
|
|
|
99205 NEW PT HIGH MDM AT LEAST 60 MINS
|
Facility
|
OP
|
$641.00
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
9299205
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$160.25 |
| Max. Negotiated Rate |
$608.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$384.60
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cigna Commercial |
$544.85
|
| Rate for Payer: First Health Commercial |
$576.90
|
| Rate for Payer: First Health Workers Compensation |
$247.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$576.90
|
| Rate for Payer: GEHA Commercial |
$512.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$576.90
|
| Rate for Payer: Humana ChoiceCare |
$166.66
|
| Rate for Payer: Multiplan All |
$583.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$384.60
|
| Rate for Payer: OMNI Networks Commercial |
$448.70
|
| Rate for Payer: One Health Plan PPO/POS |
$576.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$608.95
|
| Rate for Payer: Three Rivers Provider Network All |
$480.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$564.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$160.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$596.13
|
| Rate for Payer: Zelis Auto |
$256.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$320.50
|
| Rate for Payer: Zelis Worker's Compensation |
$174.99
|
|
|
99205 NEW PT HIGH MDM AT LEAST 60 MINS
|
Facility
|
IP
|
$641.00
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
8499205
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$174.99 |
| Max. Negotiated Rate |
$608.95 |
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cigna Commercial |
$544.85
|
| Rate for Payer: First Health Commercial |
$576.90
|
| Rate for Payer: First Health Workers Compensation |
$247.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$576.90
|
| Rate for Payer: GEHA Commercial |
$448.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$576.90
|
| Rate for Payer: Multiplan All |
$583.31
|
| Rate for Payer: OMNI Networks Commercial |
$448.70
|
| Rate for Payer: One Health Plan PPO/POS |
$576.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$608.95
|
| Rate for Payer: Three Rivers Provider Network All |
$480.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$596.13
|
| Rate for Payer: Zelis Auto |
$256.40
|
| Rate for Payer: Zelis Worker's Compensation |
$174.99
|
|
|
99205 NEW PT HIGH MDM AT LEAST 60 MINS
|
Facility
|
OP
|
$641.00
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
8999205
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$160.25 |
| Max. Negotiated Rate |
$608.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$384.60
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cigna Commercial |
$544.85
|
| Rate for Payer: First Health Commercial |
$576.90
|
| Rate for Payer: First Health Workers Compensation |
$247.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$576.90
|
| Rate for Payer: GEHA Commercial |
$512.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$576.90
|
| Rate for Payer: Humana ChoiceCare |
$166.66
|
| Rate for Payer: Multiplan All |
$583.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$384.60
|
| Rate for Payer: OMNI Networks Commercial |
$448.70
|
| Rate for Payer: One Health Plan PPO/POS |
$576.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$608.95
|
| Rate for Payer: Three Rivers Provider Network All |
$480.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$564.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$160.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$596.13
|
| Rate for Payer: Zelis Auto |
$256.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$320.50
|
| Rate for Payer: Zelis Worker's Compensation |
$174.99
|
|
|
99205 NEW PT HIGH MDM AT LEAST 60 MINS
|
Facility
|
OP
|
$641.00
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
9599205
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$160.25 |
| Max. Negotiated Rate |
$608.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$384.60
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cigna Commercial |
$544.85
|
| Rate for Payer: First Health Commercial |
$576.90
|
| Rate for Payer: First Health Workers Compensation |
$247.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$576.90
|
| Rate for Payer: GEHA Commercial |
$512.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$576.90
|
| Rate for Payer: Humana ChoiceCare |
$166.66
|
| Rate for Payer: Multiplan All |
$583.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$384.60
|
| Rate for Payer: OMNI Networks Commercial |
$448.70
|
| Rate for Payer: One Health Plan PPO/POS |
$576.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$608.95
|
| Rate for Payer: Three Rivers Provider Network All |
$480.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$564.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$160.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$596.13
|
| Rate for Payer: Zelis Auto |
$256.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$320.50
|
| Rate for Payer: Zelis Worker's Compensation |
$174.99
|
|
|
99205 NEW PT HIGH MDM AT LEAST 60 MINS
|
Facility
|
OP
|
$627.66
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
7299205
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$156.91 |
| Max. Negotiated Rate |
$596.28 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$376.60
|
| Rate for Payer: Cash Price |
$376.60
|
| Rate for Payer: Cigna Commercial |
$533.51
|
| Rate for Payer: First Health Commercial |
$564.89
|
| Rate for Payer: First Health Workers Compensation |
$242.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$564.89
|
| Rate for Payer: GEHA Commercial |
$502.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$564.89
|
| Rate for Payer: Humana ChoiceCare |
$163.19
|
| Rate for Payer: Multiplan All |
$571.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$376.60
|
| Rate for Payer: OMNI Networks Commercial |
$439.36
|
| Rate for Payer: One Health Plan PPO/POS |
$564.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$596.28
|
| Rate for Payer: Three Rivers Provider Network All |
$470.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$552.34
|
| Rate for Payer: United Healthcare Managed Medicaid |
$156.91
|
| Rate for Payer: United Payors & United Providers UP&UP |
$583.72
|
| Rate for Payer: Zelis Auto |
$251.06
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$313.83
|
| Rate for Payer: Zelis Worker's Compensation |
$171.35
|
|
|
99205 NEW PT HIGH MDM AT LEAST 60 MINS
|
Facility
|
IP
|
$627.66
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
7299205
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$171.35 |
| Max. Negotiated Rate |
$596.28 |
| Rate for Payer: Cash Price |
$376.60
|
| Rate for Payer: Cigna Commercial |
$533.51
|
| Rate for Payer: First Health Commercial |
$564.89
|
| Rate for Payer: First Health Workers Compensation |
$242.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$564.89
|
| Rate for Payer: GEHA Commercial |
$439.36
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$564.89
|
| Rate for Payer: Multiplan All |
$571.17
|
| Rate for Payer: OMNI Networks Commercial |
$439.36
|
| Rate for Payer: One Health Plan PPO/POS |
$564.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$596.28
|
| Rate for Payer: Three Rivers Provider Network All |
$470.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$583.72
|
| Rate for Payer: Zelis Auto |
$251.06
|
| Rate for Payer: Zelis Worker's Compensation |
$171.35
|
|
|
99205 NEW PT HIGH MDM AT LEAST 60 MINS
|
Facility
|
IP
|
$641.00
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
7699205
|
|
Hospital Revenue Code
|
511
|
| Min. Negotiated Rate |
$174.99 |
| Max. Negotiated Rate |
$608.95 |
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cigna Commercial |
$544.85
|
| Rate for Payer: First Health Commercial |
$576.90
|
| Rate for Payer: First Health Workers Compensation |
$247.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$576.90
|
| Rate for Payer: GEHA Commercial |
$448.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$576.90
|
| Rate for Payer: Multiplan All |
$583.31
|
| Rate for Payer: OMNI Networks Commercial |
$448.70
|
| Rate for Payer: One Health Plan PPO/POS |
$576.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$608.95
|
| Rate for Payer: Three Rivers Provider Network All |
$480.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$596.13
|
| Rate for Payer: Zelis Auto |
$256.40
|
| Rate for Payer: Zelis Worker's Compensation |
$174.99
|
|
|
99205 NEW PT HIGH MDM AT LEAST 60 MINS
|
Facility
|
IP
|
$641.00
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
8799205
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$174.99 |
| Max. Negotiated Rate |
$608.95 |
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cigna Commercial |
$544.85
|
| Rate for Payer: First Health Commercial |
$576.90
|
| Rate for Payer: First Health Workers Compensation |
$247.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$576.90
|
| Rate for Payer: GEHA Commercial |
$448.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$576.90
|
| Rate for Payer: Multiplan All |
$583.31
|
| Rate for Payer: OMNI Networks Commercial |
$448.70
|
| Rate for Payer: One Health Plan PPO/POS |
$576.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$608.95
|
| Rate for Payer: Three Rivers Provider Network All |
$480.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$596.13
|
| Rate for Payer: Zelis Auto |
$256.40
|
| Rate for Payer: Zelis Worker's Compensation |
$174.99
|
|
|
99205 NEW PT HIGH MDM AT LEAST 60 MINS
|
Facility
|
OP
|
$641.00
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
9199205
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$160.25 |
| Max. Negotiated Rate |
$608.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$384.60
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cigna Commercial |
$544.85
|
| Rate for Payer: First Health Commercial |
$576.90
|
| Rate for Payer: First Health Workers Compensation |
$247.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$576.90
|
| Rate for Payer: GEHA Commercial |
$512.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$576.90
|
| Rate for Payer: Humana ChoiceCare |
$166.66
|
| Rate for Payer: Multiplan All |
$583.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$384.60
|
| Rate for Payer: OMNI Networks Commercial |
$448.70
|
| Rate for Payer: One Health Plan PPO/POS |
$576.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$608.95
|
| Rate for Payer: Three Rivers Provider Network All |
$480.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$564.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$160.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$596.13
|
| Rate for Payer: Zelis Auto |
$256.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$320.50
|
| Rate for Payer: Zelis Worker's Compensation |
$174.99
|
|
|
99205 NEW PT HIGH MDM AT LEAST 60 MINS
|
Facility
|
IP
|
$641.00
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
9599205
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$174.99 |
| Max. Negotiated Rate |
$608.95 |
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cigna Commercial |
$544.85
|
| Rate for Payer: First Health Commercial |
$576.90
|
| Rate for Payer: First Health Workers Compensation |
$247.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$576.90
|
| Rate for Payer: GEHA Commercial |
$448.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$576.90
|
| Rate for Payer: Multiplan All |
$583.31
|
| Rate for Payer: OMNI Networks Commercial |
$448.70
|
| Rate for Payer: One Health Plan PPO/POS |
$576.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$608.95
|
| Rate for Payer: Three Rivers Provider Network All |
$480.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$596.13
|
| Rate for Payer: Zelis Auto |
$256.40
|
| Rate for Payer: Zelis Worker's Compensation |
$174.99
|
|
|
99205 NEW PT HIGH MDM AT LEAST 60 MINS
|
Facility
|
IP
|
$641.00
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
8999205
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$174.99 |
| Max. Negotiated Rate |
$608.95 |
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cigna Commercial |
$544.85
|
| Rate for Payer: First Health Commercial |
$576.90
|
| Rate for Payer: First Health Workers Compensation |
$247.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$576.90
|
| Rate for Payer: GEHA Commercial |
$448.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$576.90
|
| Rate for Payer: Multiplan All |
$583.31
|
| Rate for Payer: OMNI Networks Commercial |
$448.70
|
| Rate for Payer: One Health Plan PPO/POS |
$576.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$608.95
|
| Rate for Payer: Three Rivers Provider Network All |
$480.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$596.13
|
| Rate for Payer: Zelis Auto |
$256.40
|
| Rate for Payer: Zelis Worker's Compensation |
$174.99
|
|
|
99205 NEW PT HIGH MDM AT LEAST 60 MINS
|
Facility
|
IP
|
$641.00
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
9299205
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$174.99 |
| Max. Negotiated Rate |
$608.95 |
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cigna Commercial |
$544.85
|
| Rate for Payer: First Health Commercial |
$576.90
|
| Rate for Payer: First Health Workers Compensation |
$247.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$576.90
|
| Rate for Payer: GEHA Commercial |
$448.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$576.90
|
| Rate for Payer: Multiplan All |
$583.31
|
| Rate for Payer: OMNI Networks Commercial |
$448.70
|
| Rate for Payer: One Health Plan PPO/POS |
$576.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$608.95
|
| Rate for Payer: Three Rivers Provider Network All |
$480.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$596.13
|
| Rate for Payer: Zelis Auto |
$256.40
|
| Rate for Payer: Zelis Worker's Compensation |
$174.99
|
|
|
99205 NEW PT HIGH MDM AT LEAST 60 MINS
|
Facility
|
IP
|
$641.00
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
7999205
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$174.99 |
| Max. Negotiated Rate |
$608.95 |
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cigna Commercial |
$544.85
|
| Rate for Payer: First Health Commercial |
$576.90
|
| Rate for Payer: First Health Workers Compensation |
$247.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$576.90
|
| Rate for Payer: GEHA Commercial |
$448.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$576.90
|
| Rate for Payer: Multiplan All |
$583.31
|
| Rate for Payer: OMNI Networks Commercial |
$448.70
|
| Rate for Payer: One Health Plan PPO/POS |
$576.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$608.95
|
| Rate for Payer: Three Rivers Provider Network All |
$480.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$596.13
|
| Rate for Payer: Zelis Auto |
$256.40
|
| Rate for Payer: Zelis Worker's Compensation |
$174.99
|
|
|
99205 NEW PT HIGH MDM AT LEAST 60 MINS
|
Facility
|
OP
|
$641.00
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
7699205
|
|
Hospital Revenue Code
|
511
|
| Min. Negotiated Rate |
$160.25 |
| Max. Negotiated Rate |
$608.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$384.60
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cigna Commercial |
$544.85
|
| Rate for Payer: First Health Commercial |
$576.90
|
| Rate for Payer: First Health Workers Compensation |
$247.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$576.90
|
| Rate for Payer: GEHA Commercial |
$512.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$576.90
|
| Rate for Payer: Humana ChoiceCare |
$166.66
|
| Rate for Payer: Multiplan All |
$583.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$384.60
|
| Rate for Payer: OMNI Networks Commercial |
$448.70
|
| Rate for Payer: One Health Plan PPO/POS |
$576.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$608.95
|
| Rate for Payer: Three Rivers Provider Network All |
$480.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$564.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$160.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$596.13
|
| Rate for Payer: Zelis Auto |
$256.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$320.50
|
| Rate for Payer: Zelis Worker's Compensation |
$174.99
|
|
|
99205 NEW PT HIGH MDM AT LEAST 60 MINS
|
Facility
|
OP
|
$641.00
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
9399205
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$160.25 |
| Max. Negotiated Rate |
$608.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$384.60
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cigna Commercial |
$544.85
|
| Rate for Payer: First Health Commercial |
$576.90
|
| Rate for Payer: First Health Workers Compensation |
$247.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$576.90
|
| Rate for Payer: GEHA Commercial |
$512.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$576.90
|
| Rate for Payer: Humana ChoiceCare |
$166.66
|
| Rate for Payer: Multiplan All |
$583.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$384.60
|
| Rate for Payer: OMNI Networks Commercial |
$448.70
|
| Rate for Payer: One Health Plan PPO/POS |
$576.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$608.95
|
| Rate for Payer: Three Rivers Provider Network All |
$480.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$564.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$160.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$596.13
|
| Rate for Payer: Zelis Auto |
$256.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$320.50
|
| Rate for Payer: Zelis Worker's Compensation |
$174.99
|
|
|
99205 NEW PT HIGH MDM AT LEAST 60 MINS
|
Facility
|
OP
|
$625.00
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
8299205
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$156.25 |
| Max. Negotiated Rate |
$593.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$531.25
|
| Rate for Payer: First Health Commercial |
$562.50
|
| Rate for Payer: First Health Workers Compensation |
$241.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$562.50
|
| Rate for Payer: GEHA Commercial |
$500.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$562.50
|
| Rate for Payer: Humana ChoiceCare |
$162.50
|
| Rate for Payer: Multiplan All |
$568.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$375.00
|
| Rate for Payer: OMNI Networks Commercial |
$437.50
|
| Rate for Payer: One Health Plan PPO/POS |
$562.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$593.75
|
| Rate for Payer: Three Rivers Provider Network All |
$468.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$550.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$156.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$581.25
|
| Rate for Payer: Zelis Auto |
$250.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$312.50
|
| Rate for Payer: Zelis Worker's Compensation |
$170.62
|
|
|
99205 NEW PT HIGH MDM AT LEAST 60 MINS
|
Facility
|
IP
|
$641.00
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
9699205
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$174.99 |
| Max. Negotiated Rate |
$608.95 |
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cigna Commercial |
$544.85
|
| Rate for Payer: First Health Commercial |
$576.90
|
| Rate for Payer: First Health Workers Compensation |
$247.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$576.90
|
| Rate for Payer: GEHA Commercial |
$448.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$576.90
|
| Rate for Payer: Multiplan All |
$583.31
|
| Rate for Payer: OMNI Networks Commercial |
$448.70
|
| Rate for Payer: One Health Plan PPO/POS |
$576.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$608.95
|
| Rate for Payer: Three Rivers Provider Network All |
$480.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$596.13
|
| Rate for Payer: Zelis Auto |
$256.40
|
| Rate for Payer: Zelis Worker's Compensation |
$174.99
|
|
|
99205 NEW PT HIGH MDM AT LEAST 60 MINS
|
Facility
|
IP
|
$641.00
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
8899205
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$174.99 |
| Max. Negotiated Rate |
$608.95 |
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cigna Commercial |
$544.85
|
| Rate for Payer: First Health Commercial |
$576.90
|
| Rate for Payer: First Health Workers Compensation |
$247.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$576.90
|
| Rate for Payer: GEHA Commercial |
$448.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$576.90
|
| Rate for Payer: Multiplan All |
$583.31
|
| Rate for Payer: OMNI Networks Commercial |
$448.70
|
| Rate for Payer: One Health Plan PPO/POS |
$576.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$608.95
|
| Rate for Payer: Three Rivers Provider Network All |
$480.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$596.13
|
| Rate for Payer: Zelis Auto |
$256.40
|
| Rate for Payer: Zelis Worker's Compensation |
$174.99
|
|
|
99205 NEW PT HIGH MDM AT LEAST 60 MINS
|
Facility
|
OP
|
$641.00
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
8799205
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$160.25 |
| Max. Negotiated Rate |
$608.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$384.60
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cigna Commercial |
$544.85
|
| Rate for Payer: First Health Commercial |
$576.90
|
| Rate for Payer: First Health Workers Compensation |
$247.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$576.90
|
| Rate for Payer: GEHA Commercial |
$512.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$576.90
|
| Rate for Payer: Humana ChoiceCare |
$166.66
|
| Rate for Payer: Multiplan All |
$583.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$384.60
|
| Rate for Payer: OMNI Networks Commercial |
$448.70
|
| Rate for Payer: One Health Plan PPO/POS |
$576.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$608.95
|
| Rate for Payer: Three Rivers Provider Network All |
$480.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$564.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$160.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$596.13
|
| Rate for Payer: Zelis Auto |
$256.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$320.50
|
| Rate for Payer: Zelis Worker's Compensation |
$174.99
|
|
|
99205 OFFICE VISIT LEVEL 5 COMPL COMP
|
Professional
|
Both
|
$518.00
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
12099205
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$66.54 |
| Max. Negotiated Rate |
$492.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$178.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$169.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$178.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$189.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$172.80
|
| Rate for Payer: Cash Price |
$310.80
|
| Rate for Payer: Cash Price |
$310.80
|
| Rate for Payer: Cigna Commercial |
$310.80
|
| Rate for Payer: Cimarron Advantage Cimarron Advantage PPO |
$241.92
|
| Rate for Payer: First Health Workers Compensation |
$386.68
|
| Rate for Payer: GEHA Commercial |
$172.80
|
| Rate for Payer: GEHA Medicare |
$172.80
|
| Rate for Payer: Health Net Federal Services Government |
$172.80
|
| Rate for Payer: HealthSmart Commercial |
$241.92
|
| Rate for Payer: HealthSmart Worker's Compensation |
$371.06
|
| Rate for Payer: Humana ChoiceCare |
$190.08
|
| Rate for Payer: Humana Medicare Advantage |
$172.80
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$241.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$189.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$172.80
|
| Rate for Payer: Multiplan All |
$388.50
|
| Rate for Payer: National Preferred Provider Network Commercial |
$492.10
|
| Rate for Payer: National Preferred Provider Network Worker's Compensation |
$390.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$181.44
|
| Rate for Payer: OMNI Networks Commercial |
$362.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$168.68
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$66.54
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$181.78
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$374.98
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$169.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$169.88
|
| Rate for Payer: Zelis Medicare |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$273.41
|
|
|
99205 OFFICE VISIT LEVEL 5 COMPL COMP
|
Professional
|
Both
|
$518.00
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
14099205
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$66.54 |
| Max. Negotiated Rate |
$492.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$178.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$169.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$178.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$189.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$172.80
|
| Rate for Payer: Cash Price |
$310.80
|
| Rate for Payer: Cash Price |
$310.80
|
| Rate for Payer: Cigna Commercial |
$310.80
|
| Rate for Payer: Cimarron Advantage Cimarron Advantage PPO |
$241.92
|
| Rate for Payer: First Health Workers Compensation |
$386.68
|
| Rate for Payer: GEHA Commercial |
$172.80
|
| Rate for Payer: GEHA Medicare |
$172.80
|
| Rate for Payer: Health Net Federal Services Government |
$172.80
|
| Rate for Payer: HealthSmart Commercial |
$241.92
|
| Rate for Payer: HealthSmart Worker's Compensation |
$371.06
|
| Rate for Payer: Humana ChoiceCare |
$190.08
|
| Rate for Payer: Humana Medicare Advantage |
$172.80
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$241.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$189.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$172.80
|
| Rate for Payer: Multiplan All |
$388.50
|
| Rate for Payer: National Preferred Provider Network Commercial |
$492.10
|
| Rate for Payer: National Preferred Provider Network Worker's Compensation |
$390.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$181.44
|
| Rate for Payer: OMNI Networks Commercial |
$362.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$168.68
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$66.54
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$181.78
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$374.98
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$169.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$169.88
|
| Rate for Payer: Zelis Medicare |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$273.41
|
|
|
99205 OFFICE VISIT LEVEL 5 COMPL COMP
|
Professional
|
Both
|
$518.00
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
11099205
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$66.54 |
| Max. Negotiated Rate |
$492.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$178.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$169.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$178.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$189.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$172.80
|
| Rate for Payer: Cash Price |
$310.80
|
| Rate for Payer: Cash Price |
$310.80
|
| Rate for Payer: Cigna Commercial |
$310.80
|
| Rate for Payer: Cimarron Advantage Cimarron Advantage PPO |
$241.92
|
| Rate for Payer: First Health Workers Compensation |
$386.68
|
| Rate for Payer: GEHA Commercial |
$172.80
|
| Rate for Payer: GEHA Medicare |
$172.80
|
| Rate for Payer: Health Net Federal Services Government |
$172.80
|
| Rate for Payer: HealthSmart Commercial |
$241.92
|
| Rate for Payer: HealthSmart Worker's Compensation |
$371.06
|
| Rate for Payer: Humana ChoiceCare |
$190.08
|
| Rate for Payer: Humana Medicare Advantage |
$172.80
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$241.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$189.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$172.80
|
| Rate for Payer: Multiplan All |
$388.50
|
| Rate for Payer: National Preferred Provider Network Commercial |
$492.10
|
| Rate for Payer: National Preferred Provider Network Worker's Compensation |
$390.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$181.44
|
| Rate for Payer: OMNI Networks Commercial |
$362.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$168.68
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$66.54
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$181.78
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$374.98
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$169.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$169.88
|
| Rate for Payer: Zelis Medicare |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$273.41
|
|
|
99205 OFFICE VISIT LEVEL 5 COMPL COMP
|
Facility
|
OP
|
$625.00
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
23500006
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$156.25 |
| Max. Negotiated Rate |
$593.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$531.25
|
| Rate for Payer: First Health Commercial |
$562.50
|
| Rate for Payer: First Health Workers Compensation |
$241.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$562.50
|
| Rate for Payer: GEHA Commercial |
$500.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$562.50
|
| Rate for Payer: Humana ChoiceCare |
$162.50
|
| Rate for Payer: Multiplan All |
$568.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$375.00
|
| Rate for Payer: OMNI Networks Commercial |
$437.50
|
| Rate for Payer: One Health Plan PPO/POS |
$562.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$593.75
|
| Rate for Payer: Three Rivers Provider Network All |
$468.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$550.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$156.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$581.25
|
| Rate for Payer: Zelis Auto |
$250.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$312.50
|
| Rate for Payer: Zelis Worker's Compensation |
$170.62
|
|
|
99205 OFFICE VISIT LEVEL 5 COMPL COMP
|
Facility
|
OP
|
$625.00
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
8699205
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$156.25 |
| Max. Negotiated Rate |
$593.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$531.25
|
| Rate for Payer: First Health Commercial |
$562.50
|
| Rate for Payer: First Health Workers Compensation |
$241.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$562.50
|
| Rate for Payer: GEHA Commercial |
$500.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$562.50
|
| Rate for Payer: Humana ChoiceCare |
$162.50
|
| Rate for Payer: Multiplan All |
$568.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$375.00
|
| Rate for Payer: OMNI Networks Commercial |
$437.50
|
| Rate for Payer: One Health Plan PPO/POS |
$562.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$593.75
|
| Rate for Payer: Three Rivers Provider Network All |
$468.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$550.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$156.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$581.25
|
| Rate for Payer: Zelis Auto |
$250.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$312.50
|
| Rate for Payer: Zelis Worker's Compensation |
$170.62
|
|
