|
99213 ESTB PT LOW MDM AT LEAST 20 MINS
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
8799213
|
|
Hospital Revenue Code
|
510
|
| 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 OFFICE OP ESTAB PATIENT 15 MINUTES
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
21600056
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$55.50 |
| Max. Negotiated Rate |
$210.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$133.20
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cigna Commercial |
$188.70
|
| Rate for Payer: First Health Commercial |
$199.80
|
| Rate for Payer: First Health Workers Compensation |
$85.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$199.80
|
| Rate for Payer: GEHA Commercial |
$177.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$199.80
|
| Rate for Payer: Humana ChoiceCare |
$57.72
|
| Rate for Payer: Multiplan All |
$202.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$133.20
|
| Rate for Payer: OMNI Networks Commercial |
$155.40
|
| Rate for Payer: One Health Plan PPO/POS |
$199.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$210.90
|
| Rate for Payer: Three Rivers Provider Network All |
$166.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$195.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$55.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$206.46
|
| Rate for Payer: Zelis Auto |
$88.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$111.00
|
| Rate for Payer: Zelis Worker's Compensation |
$60.61
|
|
|
99213 OFFICE OP ESTAB PATIENT 15 MINUTES
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
9399213
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$55.50 |
| Max. Negotiated Rate |
$210.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$133.20
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cigna Commercial |
$188.70
|
| Rate for Payer: First Health Commercial |
$199.80
|
| Rate for Payer: First Health Workers Compensation |
$85.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$199.80
|
| Rate for Payer: GEHA Commercial |
$177.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$199.80
|
| Rate for Payer: Humana ChoiceCare |
$57.72
|
| Rate for Payer: Multiplan All |
$202.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$133.20
|
| Rate for Payer: OMNI Networks Commercial |
$155.40
|
| Rate for Payer: One Health Plan PPO/POS |
$199.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$210.90
|
| Rate for Payer: Three Rivers Provider Network All |
$166.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$195.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$55.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$206.46
|
| Rate for Payer: Zelis Auto |
$88.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$111.00
|
| Rate for Payer: Zelis Worker's Compensation |
$60.61
|
|
|
99213 OFFICE OP ESTAB PATIENT 15 MINUTES
|
Facility
|
IP
|
$222.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
21600056
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$60.61 |
| Max. Negotiated Rate |
$210.90 |
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cigna Commercial |
$188.70
|
| Rate for Payer: First Health Commercial |
$199.80
|
| Rate for Payer: First Health Workers Compensation |
$85.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$199.80
|
| Rate for Payer: GEHA Commercial |
$155.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$199.80
|
| Rate for Payer: Multiplan All |
$202.02
|
| Rate for Payer: OMNI Networks Commercial |
$155.40
|
| Rate for Payer: One Health Plan PPO/POS |
$199.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$210.90
|
| Rate for Payer: Three Rivers Provider Network All |
$166.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$206.46
|
| Rate for Payer: Zelis Auto |
$88.80
|
| Rate for Payer: Zelis Worker's Compensation |
$60.61
|
|
|
99213 OFFICE OP ESTAB PATIENT 15 MINUTES
|
Facility
|
IP
|
$222.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
9399213
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$60.61 |
| Max. Negotiated Rate |
$210.90 |
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cigna Commercial |
$188.70
|
| Rate for Payer: First Health Commercial |
$199.80
|
| Rate for Payer: First Health Workers Compensation |
$85.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$199.80
|
| Rate for Payer: GEHA Commercial |
$155.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$199.80
|
| Rate for Payer: Multiplan All |
$202.02
|
| Rate for Payer: OMNI Networks Commercial |
$155.40
|
| Rate for Payer: One Health Plan PPO/POS |
$199.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$210.90
|
| Rate for Payer: Three Rivers Provider Network All |
$166.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$206.46
|
| Rate for Payer: Zelis Auto |
$88.80
|
| Rate for Payer: Zelis Worker's Compensation |
$60.61
|
|
|
99213 OFFICE/OUTPATIENT VISIT
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
23500028
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$55.50 |
| Max. Negotiated Rate |
$210.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$133.20
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cigna Commercial |
$188.70
|
| Rate for Payer: First Health Commercial |
$199.80
|
| Rate for Payer: First Health Workers Compensation |
$85.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$199.80
|
| Rate for Payer: GEHA Commercial |
$177.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$199.80
|
| Rate for Payer: Humana ChoiceCare |
$57.72
|
| Rate for Payer: Multiplan All |
$202.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$133.20
|
| Rate for Payer: OMNI Networks Commercial |
$155.40
|
| Rate for Payer: One Health Plan PPO/POS |
$199.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$210.90
|
| Rate for Payer: Three Rivers Provider Network All |
$166.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$195.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$55.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$206.46
|
| Rate for Payer: Zelis Auto |
$88.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$111.00
|
| Rate for Payer: Zelis Worker's Compensation |
$60.61
|
|
|
99213 OFFICE/OUTPATIENT VISIT
|
Facility
|
IP
|
$222.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
23500028
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$60.61 |
| Max. Negotiated Rate |
$210.90 |
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cigna Commercial |
$188.70
|
| Rate for Payer: First Health Commercial |
$199.80
|
| Rate for Payer: First Health Workers Compensation |
$85.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$199.80
|
| Rate for Payer: GEHA Commercial |
$155.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$199.80
|
| Rate for Payer: Multiplan All |
$202.02
|
| Rate for Payer: OMNI Networks Commercial |
$155.40
|
| Rate for Payer: One Health Plan PPO/POS |
$199.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$210.90
|
| Rate for Payer: Three Rivers Provider Network All |
$166.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$206.46
|
| Rate for Payer: Zelis Auto |
$88.80
|
| Rate for Payer: Zelis Worker's Compensation |
$60.61
|
|
|
99213 OFFICE/OUTPATIENT VISIT,
|
Facility
|
IP
|
$222.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
8699213
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$60.61 |
| Max. Negotiated Rate |
$210.90 |
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cigna Commercial |
$188.70
|
| Rate for Payer: First Health Commercial |
$199.80
|
| Rate for Payer: First Health Workers Compensation |
$85.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$199.80
|
| Rate for Payer: GEHA Commercial |
$155.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$199.80
|
| Rate for Payer: Multiplan All |
$202.02
|
| Rate for Payer: OMNI Networks Commercial |
$155.40
|
| Rate for Payer: One Health Plan PPO/POS |
$199.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$210.90
|
| Rate for Payer: Three Rivers Provider Network All |
$166.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$206.46
|
| Rate for Payer: Zelis Auto |
$88.80
|
| Rate for Payer: Zelis Worker's Compensation |
$60.61
|
|
|
99213 OFFICE/OUTPATIENT VISIT,
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
10099213
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.64 |
| Max. Negotiated Rate |
$159.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$65.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$50.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$65.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$77.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$62.58
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cigna Commercial |
$93.60
|
| Rate for Payer: Cimarron Advantage Cimarron Advantage PPO |
$87.61
|
| Rate for Payer: First Health Workers Compensation |
$157.81
|
| Rate for Payer: GEHA Commercial |
$62.58
|
| Rate for Payer: GEHA Medicare |
$62.58
|
| Rate for Payer: Health Net Federal Services Government |
$62.58
|
| Rate for Payer: HealthSmart Commercial |
$87.61
|
| Rate for Payer: HealthSmart Worker's Compensation |
$151.43
|
| Rate for Payer: Humana ChoiceCare |
$68.84
|
| Rate for Payer: Humana Medicare Advantage |
$62.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$87.61
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$77.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$62.58
|
| Rate for Payer: Multiplan All |
$117.00
|
| Rate for Payer: National Preferred Provider Network Commercial |
$148.20
|
| Rate for Payer: National Preferred Provider Network Worker's Compensation |
$159.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$65.71
|
| Rate for Payer: OMNI Networks Commercial |
$109.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$50.06
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$23.64
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$66.08
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$135.80
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$61.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.04
|
| Rate for Payer: Zelis Medicare |
$53.19
|
| Rate for Payer: Zelis Worker's Compensation |
$111.58
|
|
|
99213 OFFICE/OUTPATIENT VISIT,
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
14099213
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.64 |
| Max. Negotiated Rate |
$159.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$65.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$50.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$65.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$77.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$62.58
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cigna Commercial |
$93.60
|
| Rate for Payer: Cimarron Advantage Cimarron Advantage PPO |
$87.61
|
| Rate for Payer: First Health Workers Compensation |
$157.81
|
| Rate for Payer: GEHA Commercial |
$62.58
|
| Rate for Payer: GEHA Medicare |
$62.58
|
| Rate for Payer: Health Net Federal Services Government |
$62.58
|
| Rate for Payer: HealthSmart Commercial |
$87.61
|
| Rate for Payer: HealthSmart Worker's Compensation |
$151.43
|
| Rate for Payer: Humana ChoiceCare |
$68.84
|
| Rate for Payer: Humana Medicare Advantage |
$62.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$87.61
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$77.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$62.58
|
| Rate for Payer: Multiplan All |
$117.00
|
| Rate for Payer: National Preferred Provider Network Commercial |
$148.20
|
| Rate for Payer: National Preferred Provider Network Worker's Compensation |
$159.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$65.71
|
| Rate for Payer: OMNI Networks Commercial |
$109.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$50.06
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$23.64
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$66.08
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$135.80
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$61.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.04
|
| Rate for Payer: Zelis Medicare |
$53.19
|
| Rate for Payer: Zelis Worker's Compensation |
$111.58
|
|
|
99213 OFFICE/OUTPATIENT VISIT,
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
12099213
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.64 |
| Max. Negotiated Rate |
$159.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$65.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$50.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$65.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$77.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$62.58
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cigna Commercial |
$93.60
|
| Rate for Payer: Cimarron Advantage Cimarron Advantage PPO |
$87.61
|
| Rate for Payer: First Health Workers Compensation |
$157.81
|
| Rate for Payer: GEHA Commercial |
$62.58
|
| Rate for Payer: GEHA Medicare |
$62.58
|
| Rate for Payer: Health Net Federal Services Government |
$62.58
|
| Rate for Payer: HealthSmart Commercial |
$87.61
|
| Rate for Payer: HealthSmart Worker's Compensation |
$151.43
|
| Rate for Payer: Humana ChoiceCare |
$68.84
|
| Rate for Payer: Humana Medicare Advantage |
$62.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$87.61
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$77.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$62.58
|
| Rate for Payer: Multiplan All |
$117.00
|
| Rate for Payer: National Preferred Provider Network Commercial |
$148.20
|
| Rate for Payer: National Preferred Provider Network Worker's Compensation |
$159.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$65.71
|
| Rate for Payer: OMNI Networks Commercial |
$109.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$50.06
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$23.64
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$66.08
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$135.80
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$61.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.04
|
| Rate for Payer: Zelis Medicare |
$53.19
|
| Rate for Payer: Zelis Worker's Compensation |
$111.58
|
|
|
99213 OFFICE/OUTPATIENT VISIT,
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
8699213
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$55.50 |
| Max. Negotiated Rate |
$210.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$133.20
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cigna Commercial |
$188.70
|
| Rate for Payer: First Health Commercial |
$199.80
|
| Rate for Payer: First Health Workers Compensation |
$85.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$199.80
|
| Rate for Payer: GEHA Commercial |
$177.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$199.80
|
| Rate for Payer: Humana ChoiceCare |
$57.72
|
| Rate for Payer: Multiplan All |
$202.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$133.20
|
| Rate for Payer: OMNI Networks Commercial |
$155.40
|
| Rate for Payer: One Health Plan PPO/POS |
$199.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$210.90
|
| Rate for Payer: Three Rivers Provider Network All |
$166.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$195.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$55.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$206.46
|
| Rate for Payer: Zelis Auto |
$88.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$111.00
|
| Rate for Payer: Zelis Worker's Compensation |
$60.61
|
|
|
99213 OFFICE/OUTPATIENT VISIT,
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
11099213
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.64 |
| Max. Negotiated Rate |
$159.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$65.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$50.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$65.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$77.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$62.58
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cigna Commercial |
$93.60
|
| Rate for Payer: Cimarron Advantage Cimarron Advantage PPO |
$87.61
|
| Rate for Payer: First Health Workers Compensation |
$157.81
|
| Rate for Payer: GEHA Commercial |
$62.58
|
| Rate for Payer: GEHA Medicare |
$62.58
|
| Rate for Payer: Health Net Federal Services Government |
$62.58
|
| Rate for Payer: HealthSmart Commercial |
$87.61
|
| Rate for Payer: HealthSmart Worker's Compensation |
$151.43
|
| Rate for Payer: Humana ChoiceCare |
$68.84
|
| Rate for Payer: Humana Medicare Advantage |
$62.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$87.61
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$77.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$62.58
|
| Rate for Payer: Multiplan All |
$117.00
|
| Rate for Payer: National Preferred Provider Network Commercial |
$148.20
|
| Rate for Payer: National Preferred Provider Network Worker's Compensation |
$159.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$65.71
|
| Rate for Payer: OMNI Networks Commercial |
$109.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$50.06
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$23.64
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$66.08
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$135.80
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$61.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.04
|
| Rate for Payer: Zelis Medicare |
$53.19
|
| Rate for Payer: Zelis Worker's Compensation |
$111.58
|
|
|
99214 ESTB PT MOD MDM AT LEAST 30 MINS
|
Facility
|
OP
|
$361.98
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
7299214
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$90.50 |
| Max. Negotiated Rate |
$343.88 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$217.19
|
| Rate for Payer: Cash Price |
$217.19
|
| Rate for Payer: Cigna Commercial |
$307.68
|
| Rate for Payer: First Health Commercial |
$325.78
|
| Rate for Payer: First Health Workers Compensation |
$139.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$325.78
|
| Rate for Payer: GEHA Commercial |
$289.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$325.78
|
| Rate for Payer: Humana ChoiceCare |
$94.11
|
| Rate for Payer: Multiplan All |
$329.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$217.19
|
| Rate for Payer: OMNI Networks Commercial |
$253.39
|
| Rate for Payer: One Health Plan PPO/POS |
$325.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$343.88
|
| Rate for Payer: Three Rivers Provider Network All |
$271.49
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$318.54
|
| Rate for Payer: United Healthcare Managed Medicaid |
$90.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$336.64
|
| Rate for Payer: Zelis Auto |
$144.79
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$180.99
|
| Rate for Payer: Zelis Worker's Compensation |
$98.82
|
|
|
99214 ESTB PT MOD MDM AT LEAST 30 MINS
|
Facility
|
IP
|
$370.00
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
8299214
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$101.01 |
| Max. Negotiated Rate |
$351.50 |
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cigna Commercial |
$314.50
|
| Rate for Payer: First Health Commercial |
$333.00
|
| Rate for Payer: First Health Workers Compensation |
$142.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$333.00
|
| Rate for Payer: GEHA Commercial |
$259.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$333.00
|
| Rate for Payer: Multiplan All |
$336.70
|
| Rate for Payer: OMNI Networks Commercial |
$259.00
|
| Rate for Payer: One Health Plan PPO/POS |
$333.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$351.50
|
| Rate for Payer: Three Rivers Provider Network All |
$277.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$344.10
|
| Rate for Payer: Zelis Auto |
$148.00
|
| Rate for Payer: Zelis Worker's Compensation |
$101.01
|
|
|
99214 ESTB PT MOD MDM AT LEAST 30 MINS
|
Facility
|
OP
|
$370.00
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
9199214
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$92.50 |
| Max. Negotiated Rate |
$351.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$222.00
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cigna Commercial |
$314.50
|
| Rate for Payer: First Health Commercial |
$333.00
|
| Rate for Payer: First Health Workers Compensation |
$142.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$333.00
|
| Rate for Payer: GEHA Commercial |
$296.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$333.00
|
| Rate for Payer: Humana ChoiceCare |
$96.20
|
| Rate for Payer: Multiplan All |
$336.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$222.00
|
| Rate for Payer: OMNI Networks Commercial |
$259.00
|
| Rate for Payer: One Health Plan PPO/POS |
$333.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$351.50
|
| Rate for Payer: Three Rivers Provider Network All |
$277.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$325.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$92.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$344.10
|
| Rate for Payer: Zelis Auto |
$148.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$185.00
|
| Rate for Payer: Zelis Worker's Compensation |
$101.01
|
|
|
99214 ESTB PT MOD MDM AT LEAST 30 MINS
|
Facility
|
IP
|
$361.98
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
8599214
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$98.82 |
| Max. Negotiated Rate |
$343.88 |
| Rate for Payer: Cash Price |
$217.19
|
| Rate for Payer: Cigna Commercial |
$307.68
|
| Rate for Payer: First Health Commercial |
$325.78
|
| Rate for Payer: First Health Workers Compensation |
$139.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$325.78
|
| Rate for Payer: GEHA Commercial |
$253.39
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$325.78
|
| Rate for Payer: Multiplan All |
$329.40
|
| Rate for Payer: OMNI Networks Commercial |
$253.39
|
| Rate for Payer: One Health Plan PPO/POS |
$325.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$343.88
|
| Rate for Payer: Three Rivers Provider Network All |
$271.49
|
| Rate for Payer: United Payors & United Providers UP&UP |
$336.64
|
| Rate for Payer: Zelis Auto |
$144.79
|
| Rate for Payer: Zelis Worker's Compensation |
$98.82
|
|
|
99214 ESTB PT MOD MDM AT LEAST 30 MINS
|
Facility
|
IP
|
$370.00
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
8499214
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$101.01 |
| Max. Negotiated Rate |
$351.50 |
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cigna Commercial |
$314.50
|
| Rate for Payer: First Health Commercial |
$333.00
|
| Rate for Payer: First Health Workers Compensation |
$142.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$333.00
|
| Rate for Payer: GEHA Commercial |
$259.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$333.00
|
| Rate for Payer: Multiplan All |
$336.70
|
| Rate for Payer: OMNI Networks Commercial |
$259.00
|
| Rate for Payer: One Health Plan PPO/POS |
$333.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$351.50
|
| Rate for Payer: Three Rivers Provider Network All |
$277.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$344.10
|
| Rate for Payer: Zelis Auto |
$148.00
|
| Rate for Payer: Zelis Worker's Compensation |
$101.01
|
|
|
99214 ESTB PT MOD MDM AT LEAST 30 MINS
|
Facility
|
IP
|
$370.00
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
9299214
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$101.01 |
| Max. Negotiated Rate |
$351.50 |
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cigna Commercial |
$314.50
|
| Rate for Payer: First Health Commercial |
$333.00
|
| Rate for Payer: First Health Workers Compensation |
$142.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$333.00
|
| Rate for Payer: GEHA Commercial |
$259.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$333.00
|
| Rate for Payer: Multiplan All |
$336.70
|
| Rate for Payer: OMNI Networks Commercial |
$259.00
|
| Rate for Payer: One Health Plan PPO/POS |
$333.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$351.50
|
| Rate for Payer: Three Rivers Provider Network All |
$277.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$344.10
|
| Rate for Payer: Zelis Auto |
$148.00
|
| Rate for Payer: Zelis Worker's Compensation |
$101.01
|
|
|
99214 ESTB PT MOD MDM AT LEAST 30 MINS
|
Facility
|
OP
|
$361.98
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
8599214
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$90.50 |
| Max. Negotiated Rate |
$343.88 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$217.19
|
| Rate for Payer: Cash Price |
$217.19
|
| Rate for Payer: Cigna Commercial |
$307.68
|
| Rate for Payer: First Health Commercial |
$325.78
|
| Rate for Payer: First Health Workers Compensation |
$139.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$325.78
|
| Rate for Payer: GEHA Commercial |
$289.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$325.78
|
| Rate for Payer: Humana ChoiceCare |
$94.11
|
| Rate for Payer: Multiplan All |
$329.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$217.19
|
| Rate for Payer: OMNI Networks Commercial |
$253.39
|
| Rate for Payer: One Health Plan PPO/POS |
$325.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$343.88
|
| Rate for Payer: Three Rivers Provider Network All |
$271.49
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$318.54
|
| Rate for Payer: United Healthcare Managed Medicaid |
$90.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$336.64
|
| Rate for Payer: Zelis Auto |
$144.79
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$180.99
|
| Rate for Payer: Zelis Worker's Compensation |
$98.82
|
|
|
99214 ESTB PT MOD MDM AT LEAST 30 MINS
|
Facility
|
OP
|
$370.00
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
21099214
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$92.50 |
| Max. Negotiated Rate |
$351.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$222.00
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cigna Commercial |
$314.50
|
| Rate for Payer: First Health Commercial |
$333.00
|
| Rate for Payer: First Health Workers Compensation |
$142.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$333.00
|
| Rate for Payer: GEHA Commercial |
$296.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$333.00
|
| Rate for Payer: Humana ChoiceCare |
$96.20
|
| Rate for Payer: Multiplan All |
$336.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$222.00
|
| Rate for Payer: OMNI Networks Commercial |
$259.00
|
| Rate for Payer: One Health Plan PPO/POS |
$333.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$351.50
|
| Rate for Payer: Three Rivers Provider Network All |
$277.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$325.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$92.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$344.10
|
| Rate for Payer: Zelis Auto |
$148.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$185.00
|
| Rate for Payer: Zelis Worker's Compensation |
$101.01
|
|
|
99214 ESTB PT MOD MDM AT LEAST 30 MINS
|
Facility
|
OP
|
$370.00
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
7699214
|
|
Hospital Revenue Code
|
511
|
| Min. Negotiated Rate |
$92.50 |
| Max. Negotiated Rate |
$351.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$222.00
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cigna Commercial |
$314.50
|
| Rate for Payer: First Health Commercial |
$333.00
|
| Rate for Payer: First Health Workers Compensation |
$142.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$333.00
|
| Rate for Payer: GEHA Commercial |
$296.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$333.00
|
| Rate for Payer: Humana ChoiceCare |
$96.20
|
| Rate for Payer: Multiplan All |
$336.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$222.00
|
| Rate for Payer: OMNI Networks Commercial |
$259.00
|
| Rate for Payer: One Health Plan PPO/POS |
$333.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$351.50
|
| Rate for Payer: Three Rivers Provider Network All |
$277.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$325.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$92.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$344.10
|
| Rate for Payer: Zelis Auto |
$148.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$185.00
|
| Rate for Payer: Zelis Worker's Compensation |
$101.01
|
|
|
99214 ESTB PT MOD MDM AT LEAST 30 MINS
|
Facility
|
OP
|
$370.00
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
7999214
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$92.50 |
| Max. Negotiated Rate |
$351.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$222.00
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cigna Commercial |
$314.50
|
| Rate for Payer: First Health Commercial |
$333.00
|
| Rate for Payer: First Health Workers Compensation |
$142.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$333.00
|
| Rate for Payer: GEHA Commercial |
$296.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$333.00
|
| Rate for Payer: Humana ChoiceCare |
$96.20
|
| Rate for Payer: Multiplan All |
$336.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$222.00
|
| Rate for Payer: OMNI Networks Commercial |
$259.00
|
| Rate for Payer: One Health Plan PPO/POS |
$333.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$351.50
|
| Rate for Payer: Three Rivers Provider Network All |
$277.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$325.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$92.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$344.10
|
| Rate for Payer: Zelis Auto |
$148.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$185.00
|
| Rate for Payer: Zelis Worker's Compensation |
$101.01
|
|
|
99214 ESTB PT MOD MDM AT LEAST 30 MINS
|
Facility
|
OP
|
$370.00
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
9699214
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$92.50 |
| Max. Negotiated Rate |
$351.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$222.00
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cigna Commercial |
$314.50
|
| Rate for Payer: First Health Commercial |
$333.00
|
| Rate for Payer: First Health Workers Compensation |
$142.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$333.00
|
| Rate for Payer: GEHA Commercial |
$296.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$333.00
|
| Rate for Payer: Humana ChoiceCare |
$96.20
|
| Rate for Payer: Multiplan All |
$336.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$222.00
|
| Rate for Payer: OMNI Networks Commercial |
$259.00
|
| Rate for Payer: One Health Plan PPO/POS |
$333.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$351.50
|
| Rate for Payer: Three Rivers Provider Network All |
$277.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$325.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$92.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$344.10
|
| Rate for Payer: Zelis Auto |
$148.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$185.00
|
| Rate for Payer: Zelis Worker's Compensation |
$101.01
|
|
|
99214 ESTB PT MOD MDM AT LEAST 30 MINS
|
Facility
|
IP
|
$370.00
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
7999214
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$101.01 |
| Max. Negotiated Rate |
$351.50 |
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cigna Commercial |
$314.50
|
| Rate for Payer: First Health Commercial |
$333.00
|
| Rate for Payer: First Health Workers Compensation |
$142.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$333.00
|
| Rate for Payer: GEHA Commercial |
$259.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$333.00
|
| Rate for Payer: Multiplan All |
$336.70
|
| Rate for Payer: OMNI Networks Commercial |
$259.00
|
| Rate for Payer: One Health Plan PPO/POS |
$333.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$351.50
|
| Rate for Payer: Three Rivers Provider Network All |
$277.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$344.10
|
| Rate for Payer: Zelis Auto |
$148.00
|
| Rate for Payer: Zelis Worker's Compensation |
$101.01
|
|
