|
99212 ESTB PT STR FWD MDM AT LEAST 10 MI
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
8799212
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$40.75 |
| Max. Negotiated Rate |
$154.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$97.80
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$138.55
|
| Rate for Payer: First Health Commercial |
$146.70
|
| Rate for Payer: First Health Workers Compensation |
$62.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$146.70
|
| Rate for Payer: GEHA Commercial |
$130.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$146.70
|
| Rate for Payer: Humana ChoiceCare |
$42.38
|
| Rate for Payer: Multiplan All |
$148.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$97.80
|
| Rate for Payer: OMNI Networks Commercial |
$114.10
|
| Rate for Payer: One Health Plan PPO/POS |
$146.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$154.85
|
| Rate for Payer: Three Rivers Provider Network All |
$122.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$143.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$40.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$151.59
|
| Rate for Payer: Zelis Auto |
$65.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$81.50
|
| Rate for Payer: Zelis Worker's Compensation |
$44.50
|
|
|
99212 ESTB PT STR FWD MDM AT LEAST 10 MI
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
7999212
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$44.50 |
| Max. Negotiated Rate |
$154.85 |
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$138.55
|
| Rate for Payer: First Health Commercial |
$146.70
|
| Rate for Payer: First Health Workers Compensation |
$62.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$146.70
|
| Rate for Payer: GEHA Commercial |
$114.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$146.70
|
| Rate for Payer: Multiplan All |
$148.33
|
| Rate for Payer: OMNI Networks Commercial |
$114.10
|
| Rate for Payer: One Health Plan PPO/POS |
$146.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$154.85
|
| Rate for Payer: Three Rivers Provider Network All |
$122.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$151.59
|
| Rate for Payer: Zelis Auto |
$65.20
|
| Rate for Payer: Zelis Worker's Compensation |
$44.50
|
|
|
99212 ESTB PT STR FWD MDM AT LEAST 10 MI
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
8499212
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$40.75 |
| Max. Negotiated Rate |
$154.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$97.80
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$138.55
|
| Rate for Payer: First Health Commercial |
$146.70
|
| Rate for Payer: First Health Workers Compensation |
$62.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$146.70
|
| Rate for Payer: GEHA Commercial |
$130.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$146.70
|
| Rate for Payer: Humana ChoiceCare |
$42.38
|
| Rate for Payer: Multiplan All |
$148.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$97.80
|
| Rate for Payer: OMNI Networks Commercial |
$114.10
|
| Rate for Payer: One Health Plan PPO/POS |
$146.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$154.85
|
| Rate for Payer: Three Rivers Provider Network All |
$122.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$143.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$40.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$151.59
|
| Rate for Payer: Zelis Auto |
$65.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$81.50
|
| Rate for Payer: Zelis Worker's Compensation |
$44.50
|
|
|
99212 ESTB PT STR FWD MDM AT LEAST 10 MI
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
7999212
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$40.75 |
| Max. Negotiated Rate |
$154.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$97.80
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$138.55
|
| Rate for Payer: First Health Commercial |
$146.70
|
| Rate for Payer: First Health Workers Compensation |
$62.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$146.70
|
| Rate for Payer: GEHA Commercial |
$130.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$146.70
|
| Rate for Payer: Humana ChoiceCare |
$42.38
|
| Rate for Payer: Multiplan All |
$148.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$97.80
|
| Rate for Payer: OMNI Networks Commercial |
$114.10
|
| Rate for Payer: One Health Plan PPO/POS |
$146.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$154.85
|
| Rate for Payer: Three Rivers Provider Network All |
$122.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$143.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$40.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$151.59
|
| Rate for Payer: Zelis Auto |
$65.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$81.50
|
| Rate for Payer: Zelis Worker's Compensation |
$44.50
|
|
|
99212 ESTB PT STR FWD MDM AT LEAST 10 MI
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
9599212
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$40.75 |
| Max. Negotiated Rate |
$154.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$97.80
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$138.55
|
| Rate for Payer: First Health Commercial |
$146.70
|
| Rate for Payer: First Health Workers Compensation |
$62.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$146.70
|
| Rate for Payer: GEHA Commercial |
$130.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$146.70
|
| Rate for Payer: Humana ChoiceCare |
$42.38
|
| Rate for Payer: Multiplan All |
$148.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$97.80
|
| Rate for Payer: OMNI Networks Commercial |
$114.10
|
| Rate for Payer: One Health Plan PPO/POS |
$146.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$154.85
|
| Rate for Payer: Three Rivers Provider Network All |
$122.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$143.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$40.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$151.59
|
| Rate for Payer: Zelis Auto |
$65.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$81.50
|
| Rate for Payer: Zelis Worker's Compensation |
$44.50
|
|
|
99212 ESTB PT STR FWD MDM AT LEAST 10 MI
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
8999212
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$40.75 |
| Max. Negotiated Rate |
$154.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$97.80
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$138.55
|
| Rate for Payer: First Health Commercial |
$146.70
|
| Rate for Payer: First Health Workers Compensation |
$62.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$146.70
|
| Rate for Payer: GEHA Commercial |
$130.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$146.70
|
| Rate for Payer: Humana ChoiceCare |
$42.38
|
| Rate for Payer: Multiplan All |
$148.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$97.80
|
| Rate for Payer: OMNI Networks Commercial |
$114.10
|
| Rate for Payer: One Health Plan PPO/POS |
$146.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$154.85
|
| Rate for Payer: Three Rivers Provider Network All |
$122.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$143.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$40.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$151.59
|
| Rate for Payer: Zelis Auto |
$65.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$81.50
|
| Rate for Payer: Zelis Worker's Compensation |
$44.50
|
|
|
99212 ESTB PT STR FWD MDM AT LEAST 10 MI
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
9699212
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.50 |
| Max. Negotiated Rate |
$154.85 |
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$138.55
|
| Rate for Payer: First Health Commercial |
$146.70
|
| Rate for Payer: First Health Workers Compensation |
$62.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$146.70
|
| Rate for Payer: GEHA Commercial |
$114.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$146.70
|
| Rate for Payer: Multiplan All |
$148.33
|
| Rate for Payer: OMNI Networks Commercial |
$114.10
|
| Rate for Payer: One Health Plan PPO/POS |
$146.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$154.85
|
| Rate for Payer: Three Rivers Provider Network All |
$122.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$151.59
|
| Rate for Payer: Zelis Auto |
$65.20
|
| Rate for Payer: Zelis Worker's Compensation |
$44.50
|
|
|
99212 ESTB PT STR FWD MDM AT LEAST 10 MI
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
9199212
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$40.75 |
| Max. Negotiated Rate |
$154.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$97.80
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$138.55
|
| Rate for Payer: First Health Commercial |
$146.70
|
| Rate for Payer: First Health Workers Compensation |
$62.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$146.70
|
| Rate for Payer: GEHA Commercial |
$130.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$146.70
|
| Rate for Payer: Humana ChoiceCare |
$42.38
|
| Rate for Payer: Multiplan All |
$148.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$97.80
|
| Rate for Payer: OMNI Networks Commercial |
$114.10
|
| Rate for Payer: One Health Plan PPO/POS |
$146.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$154.85
|
| Rate for Payer: Three Rivers Provider Network All |
$122.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$143.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$40.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$151.59
|
| Rate for Payer: Zelis Auto |
$65.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$81.50
|
| Rate for Payer: Zelis Worker's Compensation |
$44.50
|
|
|
99212 ESTB PT STR FWD MDM AT LEAST 10 MI
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
8599212
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$44.50 |
| Max. Negotiated Rate |
$154.85 |
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$138.55
|
| Rate for Payer: First Health Commercial |
$146.70
|
| Rate for Payer: First Health Workers Compensation |
$62.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$146.70
|
| Rate for Payer: GEHA Commercial |
$114.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$146.70
|
| Rate for Payer: Multiplan All |
$148.33
|
| Rate for Payer: OMNI Networks Commercial |
$114.10
|
| Rate for Payer: One Health Plan PPO/POS |
$146.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$154.85
|
| Rate for Payer: Three Rivers Provider Network All |
$122.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$151.59
|
| Rate for Payer: Zelis Auto |
$65.20
|
| Rate for Payer: Zelis Worker's Compensation |
$44.50
|
|
|
99212 ESTB PT STR FWD MDM AT LEAST 10 MI
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
20300150
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.50 |
| Max. Negotiated Rate |
$154.85 |
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$138.55
|
| Rate for Payer: First Health Commercial |
$146.70
|
| Rate for Payer: First Health Workers Compensation |
$62.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$146.70
|
| Rate for Payer: GEHA Commercial |
$114.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$146.70
|
| Rate for Payer: Multiplan All |
$148.33
|
| Rate for Payer: OMNI Networks Commercial |
$114.10
|
| Rate for Payer: One Health Plan PPO/POS |
$146.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$154.85
|
| Rate for Payer: Three Rivers Provider Network All |
$122.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$151.59
|
| Rate for Payer: Zelis Auto |
$65.20
|
| Rate for Payer: Zelis Worker's Compensation |
$44.50
|
|
|
99212 ESTB PT STR FWD MDM AT LEAST 10 MI
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
8499212
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$44.50 |
| Max. Negotiated Rate |
$154.85 |
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$138.55
|
| Rate for Payer: First Health Commercial |
$146.70
|
| Rate for Payer: First Health Workers Compensation |
$62.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$146.70
|
| Rate for Payer: GEHA Commercial |
$114.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$146.70
|
| Rate for Payer: Multiplan All |
$148.33
|
| Rate for Payer: OMNI Networks Commercial |
$114.10
|
| Rate for Payer: One Health Plan PPO/POS |
$146.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$154.85
|
| Rate for Payer: Three Rivers Provider Network All |
$122.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$151.59
|
| Rate for Payer: Zelis Auto |
$65.20
|
| Rate for Payer: Zelis Worker's Compensation |
$44.50
|
|
|
99212 OFFICE/OP ESTAB SF MDM 10-19 MIN
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
21099212
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$36.58 |
| Max. Negotiated Rate |
$127.30 |
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna Commercial |
$113.90
|
| Rate for Payer: First Health Commercial |
$120.60
|
| Rate for Payer: First Health Workers Compensation |
$51.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$120.60
|
| Rate for Payer: GEHA Commercial |
$93.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$120.60
|
| Rate for Payer: Multiplan All |
$121.94
|
| Rate for Payer: OMNI Networks Commercial |
$93.80
|
| Rate for Payer: One Health Plan PPO/POS |
$120.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$127.30
|
| Rate for Payer: Three Rivers Provider Network All |
$100.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$124.62
|
| Rate for Payer: Zelis Auto |
$53.60
|
| Rate for Payer: Zelis Worker's Compensation |
$36.58
|
|
|
99212 OFFICE/OP ESTAB SF MDM 10-19 MIN
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
21099212
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$33.50 |
| Max. Negotiated Rate |
$127.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna Commercial |
$113.90
|
| Rate for Payer: First Health Commercial |
$120.60
|
| Rate for Payer: First Health Workers Compensation |
$51.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$120.60
|
| Rate for Payer: GEHA Commercial |
$107.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$120.60
|
| Rate for Payer: Humana ChoiceCare |
$34.84
|
| Rate for Payer: Multiplan All |
$121.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$80.40
|
| Rate for Payer: OMNI Networks Commercial |
$93.80
|
| Rate for Payer: One Health Plan PPO/POS |
$120.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$127.30
|
| Rate for Payer: Three Rivers Provider Network All |
$100.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$117.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$33.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$124.62
|
| Rate for Payer: Zelis Auto |
$53.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$67.00
|
| Rate for Payer: Zelis Worker's Compensation |
$36.58
|
|
|
99212 STRAIGHT FORWARD
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
11099212
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$14.25 |
| Max. Negotiated Rate |
$98.56 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$34.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$36.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$34.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$47.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$33.35
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna Commercial |
$46.80
|
| Rate for Payer: Cimarron Advantage Cimarron Advantage PPO |
$46.69
|
| Rate for Payer: First Health Workers Compensation |
$97.57
|
| Rate for Payer: GEHA Commercial |
$33.35
|
| Rate for Payer: GEHA Medicare |
$33.35
|
| Rate for Payer: Health Net Federal Services Government |
$33.35
|
| Rate for Payer: HealthSmart Commercial |
$46.69
|
| Rate for Payer: HealthSmart Worker's Compensation |
$93.63
|
| Rate for Payer: Humana ChoiceCare |
$36.69
|
| Rate for Payer: Humana Medicare Advantage |
$33.35
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$46.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$47.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$33.35
|
| Rate for Payer: Multiplan All |
$58.50
|
| Rate for Payer: National Preferred Provider Network Commercial |
$74.10
|
| Rate for Payer: National Preferred Provider Network Worker's Compensation |
$98.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$35.02
|
| Rate for Payer: OMNI Networks Commercial |
$54.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$25.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$14.25
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$36.04
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$72.37
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$32.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.56
|
| Rate for Payer: Zelis Medicare |
$28.35
|
| Rate for Payer: Zelis Worker's Compensation |
$68.99
|
|
|
99212 STRAIGHT FORWARD
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
12099212
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$14.25 |
| Max. Negotiated Rate |
$98.56 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$34.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$36.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$34.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$47.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$33.35
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna Commercial |
$46.80
|
| Rate for Payer: Cimarron Advantage Cimarron Advantage PPO |
$46.69
|
| Rate for Payer: First Health Workers Compensation |
$97.57
|
| Rate for Payer: GEHA Commercial |
$33.35
|
| Rate for Payer: GEHA Medicare |
$33.35
|
| Rate for Payer: Health Net Federal Services Government |
$33.35
|
| Rate for Payer: HealthSmart Commercial |
$46.69
|
| Rate for Payer: HealthSmart Worker's Compensation |
$93.63
|
| Rate for Payer: Humana ChoiceCare |
$36.69
|
| Rate for Payer: Humana Medicare Advantage |
$33.35
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$46.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$47.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$33.35
|
| Rate for Payer: Multiplan All |
$58.50
|
| Rate for Payer: National Preferred Provider Network Commercial |
$74.10
|
| Rate for Payer: National Preferred Provider Network Worker's Compensation |
$98.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$35.02
|
| Rate for Payer: OMNI Networks Commercial |
$54.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$25.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$14.25
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$36.04
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$72.37
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$32.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.56
|
| Rate for Payer: Zelis Medicare |
$28.35
|
| Rate for Payer: Zelis Worker's Compensation |
$68.99
|
|
|
99212 STRAIGHT FORWARD
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
14099212
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$14.25 |
| Max. Negotiated Rate |
$98.56 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$34.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$36.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$34.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$47.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$33.35
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna Commercial |
$46.80
|
| Rate for Payer: Cimarron Advantage Cimarron Advantage PPO |
$46.69
|
| Rate for Payer: First Health Workers Compensation |
$97.57
|
| Rate for Payer: GEHA Commercial |
$33.35
|
| Rate for Payer: GEHA Medicare |
$33.35
|
| Rate for Payer: Health Net Federal Services Government |
$33.35
|
| Rate for Payer: HealthSmart Commercial |
$46.69
|
| Rate for Payer: HealthSmart Worker's Compensation |
$93.63
|
| Rate for Payer: Humana ChoiceCare |
$36.69
|
| Rate for Payer: Humana Medicare Advantage |
$33.35
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$46.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$47.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$33.35
|
| Rate for Payer: Multiplan All |
$58.50
|
| Rate for Payer: National Preferred Provider Network Commercial |
$74.10
|
| Rate for Payer: National Preferred Provider Network Worker's Compensation |
$98.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$35.02
|
| Rate for Payer: OMNI Networks Commercial |
$54.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$25.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$14.25
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$36.04
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$72.37
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$32.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.56
|
| Rate for Payer: Zelis Medicare |
$28.35
|
| Rate for Payer: Zelis Worker's Compensation |
$68.99
|
|
|
99212 STRAIGHT FORWARD
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
10099212
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$14.25 |
| Max. Negotiated Rate |
$98.56 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$34.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$36.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$34.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$47.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$33.35
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna Commercial |
$46.80
|
| Rate for Payer: Cimarron Advantage Cimarron Advantage PPO |
$46.69
|
| Rate for Payer: First Health Workers Compensation |
$97.57
|
| Rate for Payer: GEHA Commercial |
$33.35
|
| Rate for Payer: GEHA Medicare |
$33.35
|
| Rate for Payer: Health Net Federal Services Government |
$33.35
|
| Rate for Payer: HealthSmart Commercial |
$46.69
|
| Rate for Payer: HealthSmart Worker's Compensation |
$93.63
|
| Rate for Payer: Humana ChoiceCare |
$36.69
|
| Rate for Payer: Humana Medicare Advantage |
$33.35
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$46.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$47.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$33.35
|
| Rate for Payer: Multiplan All |
$58.50
|
| Rate for Payer: National Preferred Provider Network Commercial |
$74.10
|
| Rate for Payer: National Preferred Provider Network Worker's Compensation |
$98.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$35.02
|
| Rate for Payer: OMNI Networks Commercial |
$54.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$25.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$14.25
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$36.04
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$72.37
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$32.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.56
|
| Rate for Payer: Zelis Medicare |
$28.35
|
| Rate for Payer: Zelis Worker's Compensation |
$68.99
|
|
|
99212 STRAIGHT FORWARD
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
8899212
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$33.50 |
| Max. Negotiated Rate |
$127.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna Commercial |
$113.90
|
| Rate for Payer: First Health Commercial |
$120.60
|
| Rate for Payer: First Health Workers Compensation |
$51.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$120.60
|
| Rate for Payer: GEHA Commercial |
$107.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$120.60
|
| Rate for Payer: Humana ChoiceCare |
$34.84
|
| Rate for Payer: Multiplan All |
$121.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$80.40
|
| Rate for Payer: OMNI Networks Commercial |
$93.80
|
| Rate for Payer: One Health Plan PPO/POS |
$120.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$127.30
|
| Rate for Payer: Three Rivers Provider Network All |
$100.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$117.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$33.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$124.62
|
| Rate for Payer: Zelis Auto |
$53.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$67.00
|
| Rate for Payer: Zelis Worker's Compensation |
$36.58
|
|
|
99212 STRAIGHT FORWARD
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
8699212
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$36.58 |
| Max. Negotiated Rate |
$127.30 |
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna Commercial |
$113.90
|
| Rate for Payer: First Health Commercial |
$120.60
|
| Rate for Payer: First Health Workers Compensation |
$51.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$120.60
|
| Rate for Payer: GEHA Commercial |
$93.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$120.60
|
| Rate for Payer: Multiplan All |
$121.94
|
| Rate for Payer: OMNI Networks Commercial |
$93.80
|
| Rate for Payer: One Health Plan PPO/POS |
$120.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$127.30
|
| Rate for Payer: Three Rivers Provider Network All |
$100.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$124.62
|
| Rate for Payer: Zelis Auto |
$53.60
|
| Rate for Payer: Zelis Worker's Compensation |
$36.58
|
|
|
99212 STRAIGHT FORWARD
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
23500027
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$33.50 |
| Max. Negotiated Rate |
$127.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna Commercial |
$113.90
|
| Rate for Payer: First Health Commercial |
$120.60
|
| Rate for Payer: First Health Workers Compensation |
$51.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$120.60
|
| Rate for Payer: GEHA Commercial |
$107.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$120.60
|
| Rate for Payer: Humana ChoiceCare |
$34.84
|
| Rate for Payer: Multiplan All |
$121.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$80.40
|
| Rate for Payer: OMNI Networks Commercial |
$93.80
|
| Rate for Payer: One Health Plan PPO/POS |
$120.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$127.30
|
| Rate for Payer: Three Rivers Provider Network All |
$100.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$117.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$33.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$124.62
|
| Rate for Payer: Zelis Auto |
$53.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$67.00
|
| Rate for Payer: Zelis Worker's Compensation |
$36.58
|
|
|
99212 STRAIGHT FORWARD
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
23500027
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$36.58 |
| Max. Negotiated Rate |
$127.30 |
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna Commercial |
$113.90
|
| Rate for Payer: First Health Commercial |
$120.60
|
| Rate for Payer: First Health Workers Compensation |
$51.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$120.60
|
| Rate for Payer: GEHA Commercial |
$93.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$120.60
|
| Rate for Payer: Multiplan All |
$121.94
|
| Rate for Payer: OMNI Networks Commercial |
$93.80
|
| Rate for Payer: One Health Plan PPO/POS |
$120.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$127.30
|
| Rate for Payer: Three Rivers Provider Network All |
$100.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$124.62
|
| Rate for Payer: Zelis Auto |
$53.60
|
| Rate for Payer: Zelis Worker's Compensation |
$36.58
|
|
|
99212 STRAIGHT FORWARD
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
8699212
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$33.50 |
| Max. Negotiated Rate |
$127.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna Commercial |
$113.90
|
| Rate for Payer: First Health Commercial |
$120.60
|
| Rate for Payer: First Health Workers Compensation |
$51.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$120.60
|
| Rate for Payer: GEHA Commercial |
$107.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$120.60
|
| Rate for Payer: Humana ChoiceCare |
$34.84
|
| Rate for Payer: Multiplan All |
$121.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$80.40
|
| Rate for Payer: OMNI Networks Commercial |
$93.80
|
| Rate for Payer: One Health Plan PPO/POS |
$120.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$127.30
|
| Rate for Payer: Three Rivers Provider Network All |
$100.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$117.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$33.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$124.62
|
| Rate for Payer: Zelis Auto |
$53.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$67.00
|
| Rate for Payer: Zelis Worker's Compensation |
$36.58
|
|
|
99212 STRAIGHT FORWARD
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
8899212
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$36.58 |
| Max. Negotiated Rate |
$127.30 |
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna Commercial |
$113.90
|
| Rate for Payer: First Health Commercial |
$120.60
|
| Rate for Payer: First Health Workers Compensation |
$51.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$120.60
|
| Rate for Payer: GEHA Commercial |
$93.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$120.60
|
| Rate for Payer: Multiplan All |
$121.94
|
| Rate for Payer: OMNI Networks Commercial |
$93.80
|
| Rate for Payer: One Health Plan PPO/POS |
$120.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$127.30
|
| Rate for Payer: Three Rivers Provider Network All |
$100.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$124.62
|
| Rate for Payer: Zelis Auto |
$53.60
|
| Rate for Payer: Zelis Worker's Compensation |
$36.58
|
|
|
99213 ESTB PT LOW MDM AT LEAST 20 MINS
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
7699213
|
|
Hospital Revenue Code
|
511
|
| Min. Negotiated Rate |
$65.25 |
| Max. Negotiated Rate |
$247.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$156.60
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cigna Commercial |
$221.85
|
| Rate for Payer: First Health Commercial |
$234.90
|
| Rate for Payer: First Health Workers Compensation |
$100.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$234.90
|
| Rate for Payer: GEHA Commercial |
$208.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$234.90
|
| Rate for Payer: Humana ChoiceCare |
$67.86
|
| Rate for Payer: Multiplan All |
$237.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$156.60
|
| Rate for Payer: OMNI Networks Commercial |
$182.70
|
| Rate for Payer: One Health Plan PPO/POS |
$234.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$247.95
|
| Rate for Payer: Three Rivers Provider Network All |
$195.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$229.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$65.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$242.73
|
| Rate for Payer: Zelis Auto |
$104.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$130.50
|
| Rate for Payer: Zelis Worker's Compensation |
$71.25
|
|
|
99213 ESTB PT LOW MDM AT LEAST 20 MINS
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
8499213
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$71.25 |
| Max. Negotiated Rate |
$247.95 |
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cigna Commercial |
$221.85
|
| Rate for Payer: First Health Commercial |
$234.90
|
| Rate for Payer: First Health Workers Compensation |
$100.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$234.90
|
| Rate for Payer: GEHA Commercial |
$182.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$234.90
|
| Rate for Payer: Multiplan All |
$237.51
|
| Rate for Payer: OMNI Networks Commercial |
$182.70
|
| Rate for Payer: One Health Plan PPO/POS |
$234.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$247.95
|
| Rate for Payer: Three Rivers Provider Network All |
$195.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$242.73
|
| Rate for Payer: Zelis Auto |
$104.40
|
| Rate for Payer: Zelis Worker's Compensation |
$71.25
|
|
