|
E/M ESTAB PATIENT NURSE VISIT - FACILITY
|
Facility
|
IP
|
$433.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
1999211
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$118.21 |
| Max. Negotiated Rate |
$411.35 |
| Rate for Payer: Cash Price |
$259.80
|
| Rate for Payer: Cigna Commercial |
$368.05
|
| Rate for Payer: First Health Commercial |
$389.70
|
| Rate for Payer: First Health Workers Compensation |
$167.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$389.70
|
| Rate for Payer: GEHA Commercial |
$303.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$389.70
|
| Rate for Payer: Multiplan All |
$394.03
|
| Rate for Payer: OMNI Networks Commercial |
$303.10
|
| Rate for Payer: One Health Plan PPO/POS |
$389.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$411.35
|
| Rate for Payer: Three Rivers Provider Network All |
$324.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$402.69
|
| Rate for Payer: Zelis Auto |
$173.20
|
| Rate for Payer: Zelis Worker's Compensation |
$118.21
|
|
|
E/M ESTAB PATIENT NURSE VISIT - PROFEE
|
Facility
|
OP
|
$65.49
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
1991007
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$16.37 |
| Max. Negotiated Rate |
$62.22 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$39.29
|
| Rate for Payer: Cash Price |
$39.29
|
| Rate for Payer: Cigna Commercial |
$55.67
|
| Rate for Payer: First Health Commercial |
$58.94
|
| Rate for Payer: First Health Workers Compensation |
$25.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$58.94
|
| Rate for Payer: GEHA Commercial |
$52.39
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$58.94
|
| Rate for Payer: Humana ChoiceCare |
$17.03
|
| Rate for Payer: Multiplan All |
$59.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$39.29
|
| Rate for Payer: OMNI Networks Commercial |
$45.84
|
| Rate for Payer: One Health Plan PPO/POS |
$58.94
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$62.22
|
| Rate for Payer: Three Rivers Provider Network All |
$49.12
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$57.63
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$60.91
|
| Rate for Payer: Zelis Auto |
$26.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$32.74
|
| Rate for Payer: Zelis Worker's Compensation |
$17.88
|
|
|
E/M ESTAB PATIENT NURSE VISIT - PROFEE
|
Facility
|
IP
|
$65.49
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
1991007
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$17.88 |
| Max. Negotiated Rate |
$62.22 |
| Rate for Payer: Cash Price |
$39.29
|
| Rate for Payer: Cigna Commercial |
$55.67
|
| Rate for Payer: First Health Commercial |
$58.94
|
| Rate for Payer: First Health Workers Compensation |
$25.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$58.94
|
| Rate for Payer: GEHA Commercial |
$45.84
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$58.94
|
| Rate for Payer: Multiplan All |
$59.60
|
| Rate for Payer: OMNI Networks Commercial |
$45.84
|
| Rate for Payer: One Health Plan PPO/POS |
$58.94
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$62.22
|
| Rate for Payer: Three Rivers Provider Network All |
$49.12
|
| Rate for Payer: United Payors & United Providers UP&UP |
$60.91
|
| Rate for Payer: Zelis Auto |
$26.20
|
| Rate for Payer: Zelis Worker's Compensation |
$17.88
|
|
|
E/M ESTB PT LOW MDM AT LEAST 20 MINS - F
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
1991009
|
|
Hospital Revenue Code
|
982
|
| 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
|
|
|
E/M ESTB PT LOW MDM AT LEAST 20 MINS - F
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
1991009
|
|
Hospital Revenue Code
|
982
|
| 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
|
|
|
E/M ESTB PT LOW MDM AT LEAST 20 MINS - P
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
1999213
|
|
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
|
|
|
E/M ESTB PT LOW MDM AT LEAST 20 MINS - P
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
1999213
|
|
Hospital Revenue Code
|
510
|
| 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
|
|
|
E/M ESTB PT MOD MDM AT LEAST 30 MINS - F
|
Facility
|
IP
|
$370.00
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
1999214
|
|
Hospital Revenue Code
|
510
|
| 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
|
|
|
E/M ESTB PT MOD MDM AT LEAST 30 MINS - F
|
Facility
|
OP
|
$370.00
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
1999214
|
|
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
|
|
|
E/M ESTB PT MOD MDM AT LEAST 30 MINS - P
|
Facility
|
IP
|
$370.00
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
1991010
|
|
Hospital Revenue Code
|
982
|
| 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
|
|
|
E/M ESTB PT MOD MDM AT LEAST 30 MINS - P
|
Facility
|
OP
|
$370.00
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
1991010
|
|
Hospital Revenue Code
|
982
|
| 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
|
|
|
E/M ESTB PT STR FWD MDM AT LEAST 10 MINS
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
1991008
|
|
Hospital Revenue Code
|
982
|
| 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
|
|
|
E/M ESTB PT STR FWD MDM AT LEAST 10 MINS
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
1999212
|
|
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
|
|
|
E/M ESTB PT STR FWD MDM AT LEAST 10 MINS
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
1991008
|
|
Hospital Revenue Code
|
982
|
| 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
|
|
|
E/M ESTB PT STR FWD MDM AT LEAST 10 MINS
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
1999212
|
|
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
|
|
|
E/M EST PT HI MDM AT LST 40 MINS - FAC
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
1999215
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$494.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$312.00
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cigna Commercial |
$442.00
|
| Rate for Payer: First Health Commercial |
$468.00
|
| Rate for Payer: First Health Workers Compensation |
$200.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$468.00
|
| Rate for Payer: GEHA Commercial |
$416.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$468.00
|
| Rate for Payer: Humana ChoiceCare |
$135.20
|
| Rate for Payer: Multiplan All |
$473.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$312.00
|
| Rate for Payer: OMNI Networks Commercial |
$364.00
|
| Rate for Payer: One Health Plan PPO/POS |
$468.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$494.00
|
| Rate for Payer: Three Rivers Provider Network All |
$390.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$457.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$130.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$483.60
|
| Rate for Payer: Zelis Auto |
$208.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$260.00
|
| Rate for Payer: Zelis Worker's Compensation |
$141.96
|
|
|
E/M EST PT HI MDM AT LST 40 MINS - FAC
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
1999215
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$141.96 |
| Max. Negotiated Rate |
$494.00 |
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cigna Commercial |
$442.00
|
| Rate for Payer: First Health Commercial |
$468.00
|
| Rate for Payer: First Health Workers Compensation |
$200.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$468.00
|
| Rate for Payer: GEHA Commercial |
$364.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$468.00
|
| Rate for Payer: Multiplan All |
$473.20
|
| Rate for Payer: OMNI Networks Commercial |
$364.00
|
| Rate for Payer: One Health Plan PPO/POS |
$468.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$494.00
|
| Rate for Payer: Three Rivers Provider Network All |
$390.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$483.60
|
| Rate for Payer: Zelis Auto |
$208.00
|
| Rate for Payer: Zelis Worker's Compensation |
$141.96
|
|
|
E/M EST PT HI MDM AT LST 40 MINS - PRO
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
1991011
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$494.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$312.00
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cigna Commercial |
$442.00
|
| Rate for Payer: First Health Commercial |
$468.00
|
| Rate for Payer: First Health Workers Compensation |
$200.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$468.00
|
| Rate for Payer: GEHA Commercial |
$416.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$468.00
|
| Rate for Payer: Humana ChoiceCare |
$135.20
|
| Rate for Payer: Multiplan All |
$473.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$312.00
|
| Rate for Payer: OMNI Networks Commercial |
$364.00
|
| Rate for Payer: One Health Plan PPO/POS |
$468.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$494.00
|
| Rate for Payer: Three Rivers Provider Network All |
$390.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$457.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$130.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$483.60
|
| Rate for Payer: Zelis Auto |
$208.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$260.00
|
| Rate for Payer: Zelis Worker's Compensation |
$141.96
|
|
|
E/M EST PT HI MDM AT LST 40 MINS - PRO
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
1991011
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$141.96 |
| Max. Negotiated Rate |
$494.00 |
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cigna Commercial |
$442.00
|
| Rate for Payer: First Health Commercial |
$468.00
|
| Rate for Payer: First Health Workers Compensation |
$200.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$468.00
|
| Rate for Payer: GEHA Commercial |
$364.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$468.00
|
| Rate for Payer: Multiplan All |
$473.20
|
| Rate for Payer: OMNI Networks Commercial |
$364.00
|
| Rate for Payer: One Health Plan PPO/POS |
$468.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$494.00
|
| Rate for Payer: Three Rivers Provider Network All |
$390.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$483.60
|
| Rate for Payer: Zelis Auto |
$208.00
|
| Rate for Payer: Zelis Worker's Compensation |
$141.96
|
|
|
EMG STDS ANAL/URTL SPHNCTR OTH/THN NDL
|
Facility
|
IP
|
$563.00
|
|
|
Service Code
|
CPT 51784
|
| Hospital Charge Code |
9200001
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$153.70 |
| Max. Negotiated Rate |
$534.85 |
| Rate for Payer: Cash Price |
$337.80
|
| Rate for Payer: Cigna Commercial |
$478.55
|
| Rate for Payer: First Health Commercial |
$506.70
|
| Rate for Payer: First Health Workers Compensation |
$217.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$506.70
|
| Rate for Payer: GEHA Commercial |
$394.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$506.70
|
| Rate for Payer: Multiplan All |
$512.33
|
| Rate for Payer: OMNI Networks Commercial |
$394.10
|
| Rate for Payer: One Health Plan PPO/POS |
$506.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$534.85
|
| Rate for Payer: Three Rivers Provider Network All |
$422.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$523.59
|
| Rate for Payer: Zelis Auto |
$225.20
|
| Rate for Payer: Zelis Worker's Compensation |
$153.70
|
|
|
EMG STDS ANAL/URTL SPHNCTR OTH/THN NDL
|
Facility
|
OP
|
$563.00
|
|
|
Service Code
|
CPT 51784
|
| Hospital Charge Code |
23500051
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$87.77 |
| Max. Negotiated Rate |
$534.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$110.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$337.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$110.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$87.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$148.57
|
| Rate for Payer: Cash Price |
$337.80
|
| Rate for Payer: Cash Price |
$337.80
|
| Rate for Payer: Cigna Commercial |
$478.55
|
| Rate for Payer: First Health Commercial |
$506.70
|
| Rate for Payer: First Health Workers Compensation |
$217.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$506.70
|
| Rate for Payer: GEHA Commercial |
$450.40
|
| Rate for Payer: GEHA Medicare |
$148.57
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$506.70
|
| Rate for Payer: Humana ChoiceCare |
$163.43
|
| Rate for Payer: Humana Medicare Advantage |
$148.57
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$249.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$89.56
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$148.57
|
| Rate for Payer: Multiplan All |
$512.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$252.57
|
| Rate for Payer: OMNI Networks Commercial |
$394.10
|
| Rate for Payer: One Health Plan PPO/POS |
$506.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$103.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$89.56
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$148.57
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$534.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$297.14
|
| Rate for Payer: Three Rivers Provider Network All |
$422.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$145.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$89.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$148.57
|
| Rate for Payer: United Payors & United Providers UP&UP |
$523.59
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$148.57
|
| Rate for Payer: Zelis Auto |
$225.20
|
| Rate for Payer: Zelis Medicare |
$126.28
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$178.28
|
| Rate for Payer: Zelis Worker's Compensation |
$153.70
|
|
|
EMG STDS ANAL/URTL SPHNCTR OTH/THN NDL
|
Facility
|
IP
|
$563.00
|
|
|
Service Code
|
CPT 51784
|
| Hospital Charge Code |
23500051
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$153.70 |
| Max. Negotiated Rate |
$534.85 |
| Rate for Payer: Cash Price |
$337.80
|
| Rate for Payer: Cigna Commercial |
$478.55
|
| Rate for Payer: First Health Commercial |
$506.70
|
| Rate for Payer: First Health Workers Compensation |
$217.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$506.70
|
| Rate for Payer: GEHA Commercial |
$394.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$506.70
|
| Rate for Payer: Multiplan All |
$512.33
|
| Rate for Payer: OMNI Networks Commercial |
$394.10
|
| Rate for Payer: One Health Plan PPO/POS |
$506.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$534.85
|
| Rate for Payer: Three Rivers Provider Network All |
$422.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$523.59
|
| Rate for Payer: Zelis Auto |
$225.20
|
| Rate for Payer: Zelis Worker's Compensation |
$153.70
|
|
|
EMG STDS ANAL/URTL SPHNCTR OTH/THN NDL
|
Facility
|
IP
|
$1,143.00
|
|
|
Service Code
|
CPT 51784
|
| Hospital Charge Code |
6151784
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$312.04 |
| Max. Negotiated Rate |
$1,085.85 |
| Rate for Payer: Cash Price |
$685.80
|
| Rate for Payer: Cigna Commercial |
$971.55
|
| Rate for Payer: First Health Commercial |
$1,028.70
|
| Rate for Payer: First Health Workers Compensation |
$441.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,028.70
|
| Rate for Payer: GEHA Commercial |
$800.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,028.70
|
| Rate for Payer: Multiplan All |
$1,040.13
|
| Rate for Payer: OMNI Networks Commercial |
$800.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,028.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,085.85
|
| Rate for Payer: Three Rivers Provider Network All |
$857.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,062.99
|
| Rate for Payer: Zelis Auto |
$457.20
|
| Rate for Payer: Zelis Worker's Compensation |
$312.04
|
|
|
EMG STDS ANAL/URTL SPHNCTR OTH/THN NDL
|
Facility
|
OP
|
$563.00
|
|
|
Service Code
|
CPT 51784
|
| Hospital Charge Code |
9200001
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$87.77 |
| Max. Negotiated Rate |
$534.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$110.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$337.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$110.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$87.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$148.57
|
| Rate for Payer: Cash Price |
$337.80
|
| Rate for Payer: Cash Price |
$337.80
|
| Rate for Payer: Cigna Commercial |
$478.55
|
| Rate for Payer: First Health Commercial |
$506.70
|
| Rate for Payer: First Health Workers Compensation |
$217.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$506.70
|
| Rate for Payer: GEHA Commercial |
$450.40
|
| Rate for Payer: GEHA Medicare |
$148.57
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$506.70
|
| Rate for Payer: Humana ChoiceCare |
$163.43
|
| Rate for Payer: Humana Medicare Advantage |
$148.57
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$249.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$89.56
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$148.57
|
| Rate for Payer: Multiplan All |
$512.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$252.57
|
| Rate for Payer: OMNI Networks Commercial |
$394.10
|
| Rate for Payer: One Health Plan PPO/POS |
$506.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$103.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$89.56
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$148.57
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$534.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$297.14
|
| Rate for Payer: Three Rivers Provider Network All |
$422.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$145.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$89.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$148.57
|
| Rate for Payer: United Payors & United Providers UP&UP |
$523.59
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$148.57
|
| Rate for Payer: Zelis Auto |
$225.20
|
| Rate for Payer: Zelis Medicare |
$126.28
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$178.28
|
| Rate for Payer: Zelis Worker's Compensation |
$153.70
|
|
|
EMG STDS ANAL/URTL SPHNCTR OTH/THN NDL
|
Facility
|
OP
|
$1,143.00
|
|
|
Service Code
|
CPT 51784
|
| Hospital Charge Code |
6151784
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$87.77 |
| Max. Negotiated Rate |
$1,085.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$110.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$685.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$110.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$87.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$148.57
|
| Rate for Payer: Cash Price |
$685.80
|
| Rate for Payer: Cash Price |
$685.80
|
| Rate for Payer: Cigna Commercial |
$971.55
|
| Rate for Payer: First Health Commercial |
$1,028.70
|
| Rate for Payer: First Health Workers Compensation |
$441.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,028.70
|
| Rate for Payer: GEHA Commercial |
$914.40
|
| Rate for Payer: GEHA Medicare |
$148.57
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,028.70
|
| Rate for Payer: Humana ChoiceCare |
$163.43
|
| Rate for Payer: Humana Medicare Advantage |
$148.57
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$249.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$89.56
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$148.57
|
| Rate for Payer: Multiplan All |
$1,040.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$252.57
|
| Rate for Payer: OMNI Networks Commercial |
$800.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,028.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$103.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$89.56
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$148.57
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,085.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$297.14
|
| Rate for Payer: Three Rivers Provider Network All |
$857.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$145.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$89.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$148.57
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,062.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$148.57
|
| Rate for Payer: Zelis Auto |
$457.20
|
| Rate for Payer: Zelis Medicare |
$126.28
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$178.28
|
| Rate for Payer: Zelis Worker's Compensation |
$312.04
|
|
