|
99214 MODERATE COMPLEXITY
|
Professional
|
Both
|
$241.00
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
14099214
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.67 |
| Max. Negotiated Rate |
$228.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$96.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$79.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$96.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$109.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$92.17
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cigna Commercial |
$144.60
|
| Rate for Payer: Cimarron Advantage Cimarron Advantage PPO |
$129.04
|
| Rate for Payer: First Health Workers Compensation |
$223.46
|
| Rate for Payer: GEHA Commercial |
$92.17
|
| Rate for Payer: GEHA Medicare |
$92.17
|
| Rate for Payer: Health Net Federal Services Government |
$92.16
|
| Rate for Payer: HealthSmart Commercial |
$129.04
|
| Rate for Payer: HealthSmart Worker's Compensation |
$214.43
|
| Rate for Payer: Humana ChoiceCare |
$101.39
|
| Rate for Payer: Humana Medicare Advantage |
$92.17
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$129.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$109.31
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$92.17
|
| Rate for Payer: Multiplan All |
$180.75
|
| Rate for Payer: National Preferred Provider Network Commercial |
$228.95
|
| Rate for Payer: National Preferred Provider Network Worker's Compensation |
$225.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$96.78
|
| Rate for Payer: OMNI Networks Commercial |
$168.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$78.16
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$34.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$96.71
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$200.01
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$90.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$78.62
|
| Rate for Payer: Zelis Medicare |
$78.34
|
| Rate for Payer: Zelis Worker's Compensation |
$158.00
|
|
|
99215 ESTB PT HIGH MDM AT LEAST 40 MINS
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
21099215
|
|
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
|
|
|
99215 ESTB PT HIGH MDM AT LEAST 40 MINS
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
9199215
|
|
Hospital Revenue Code
|
521
|
| 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
|
|
|
99215 ESTB PT HIGH MDM AT LEAST 40 MINS
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
8899215
|
|
Hospital Revenue Code
|
519
|
| 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
|
|
|
99215 ESTB PT HIGH MDM AT LEAST 40 MINS
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
8799215
|
|
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
|
|
|
99215 ESTB PT HIGH MDM AT LEAST 40 MINS
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
9399215
|
|
Hospital Revenue Code
|
517
|
| 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
|
|
|
99215 ESTB PT HIGH MDM AT LEAST 40 MINS
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
8299215
|
|
Hospital Revenue Code
|
519
|
| 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
|
|
|
99215 ESTB PT HIGH MDM AT LEAST 40 MINS
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
9399215
|
|
Hospital Revenue Code
|
517
|
| 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
|
|
|
99215 ESTB PT HIGH MDM AT LEAST 40 MINS
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
9299215
|
|
Hospital Revenue Code
|
519
|
| 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
|
|
|
99215 ESTB PT HIGH MDM AT LEAST 40 MINS
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
8499215
|
|
Hospital Revenue Code
|
521
|
| 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
|
|
|
99215 ESTB PT HIGH MDM AT LEAST 40 MINS
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
21099215
|
|
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
|
|
|
99215 ESTB PT HIGH MDM AT LEAST 40 MINS
|
Facility
|
OP
|
$508.83
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
7299215
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$127.21 |
| Max. Negotiated Rate |
$483.39 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$305.30
|
| Rate for Payer: Cash Price |
$305.30
|
| Rate for Payer: Cigna Commercial |
$432.51
|
| Rate for Payer: First Health Commercial |
$457.95
|
| Rate for Payer: First Health Workers Compensation |
$196.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$457.95
|
| Rate for Payer: GEHA Commercial |
$407.06
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$457.95
|
| Rate for Payer: Humana ChoiceCare |
$132.30
|
| Rate for Payer: Multiplan All |
$463.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$305.30
|
| Rate for Payer: OMNI Networks Commercial |
$356.18
|
| Rate for Payer: One Health Plan PPO/POS |
$457.95
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$483.39
|
| Rate for Payer: Three Rivers Provider Network All |
$381.62
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$447.77
|
| Rate for Payer: United Healthcare Managed Medicaid |
$127.21
|
| Rate for Payer: United Payors & United Providers UP&UP |
$473.21
|
| Rate for Payer: Zelis Auto |
$203.53
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$254.41
|
| Rate for Payer: Zelis Worker's Compensation |
$138.91
|
|
|
99215 ESTB PT HIGH MDM AT LEAST 40 MINS
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
8999215
|
|
Hospital Revenue Code
|
519
|
| 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
|
|
|
99215 ESTB PT HIGH MDM AT LEAST 40 MINS
|
Facility
|
OP
|
$508.83
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
8599215
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$127.21 |
| Max. Negotiated Rate |
$483.39 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$305.30
|
| Rate for Payer: Cash Price |
$305.30
|
| Rate for Payer: Cigna Commercial |
$432.51
|
| Rate for Payer: First Health Commercial |
$457.95
|
| Rate for Payer: First Health Workers Compensation |
$196.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$457.95
|
| Rate for Payer: GEHA Commercial |
$407.06
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$457.95
|
| Rate for Payer: Humana ChoiceCare |
$132.30
|
| Rate for Payer: Multiplan All |
$463.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$305.30
|
| Rate for Payer: OMNI Networks Commercial |
$356.18
|
| Rate for Payer: One Health Plan PPO/POS |
$457.95
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$483.39
|
| Rate for Payer: Three Rivers Provider Network All |
$381.62
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$447.77
|
| Rate for Payer: United Healthcare Managed Medicaid |
$127.21
|
| Rate for Payer: United Payors & United Providers UP&UP |
$473.21
|
| Rate for Payer: Zelis Auto |
$203.53
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$254.41
|
| Rate for Payer: Zelis Worker's Compensation |
$138.91
|
|
|
99215 ESTB PT HIGH MDM AT LEAST 40 MINS
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
9199215
|
|
Hospital Revenue Code
|
521
|
| 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
|
|
|
99215 ESTB PT HIGH MDM AT LEAST 40 MINS
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
8499215
|
|
Hospital Revenue Code
|
521
|
| 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
|
|
|
99215 ESTB PT HIGH MDM AT LEAST 40 MINS
|
Facility
|
IP
|
$508.83
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
7299215
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$138.91 |
| Max. Negotiated Rate |
$483.39 |
| Rate for Payer: Cash Price |
$305.30
|
| Rate for Payer: Cigna Commercial |
$432.51
|
| Rate for Payer: First Health Commercial |
$457.95
|
| Rate for Payer: First Health Workers Compensation |
$196.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$457.95
|
| Rate for Payer: GEHA Commercial |
$356.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$457.95
|
| Rate for Payer: Multiplan All |
$463.04
|
| Rate for Payer: OMNI Networks Commercial |
$356.18
|
| Rate for Payer: One Health Plan PPO/POS |
$457.95
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$483.39
|
| Rate for Payer: Three Rivers Provider Network All |
$381.62
|
| Rate for Payer: United Payors & United Providers UP&UP |
$473.21
|
| Rate for Payer: Zelis Auto |
$203.53
|
| Rate for Payer: Zelis Worker's Compensation |
$138.91
|
|
|
99215 ESTB PT HIGH MDM AT LEAST 40 MINS
|
Facility
|
IP
|
$508.83
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
8599215
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$138.91 |
| Max. Negotiated Rate |
$483.39 |
| Rate for Payer: Cash Price |
$305.30
|
| Rate for Payer: Cigna Commercial |
$432.51
|
| Rate for Payer: First Health Commercial |
$457.95
|
| Rate for Payer: First Health Workers Compensation |
$196.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$457.95
|
| Rate for Payer: GEHA Commercial |
$356.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$457.95
|
| Rate for Payer: Multiplan All |
$463.04
|
| Rate for Payer: OMNI Networks Commercial |
$356.18
|
| Rate for Payer: One Health Plan PPO/POS |
$457.95
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$483.39
|
| Rate for Payer: Three Rivers Provider Network All |
$381.62
|
| Rate for Payer: United Payors & United Providers UP&UP |
$473.21
|
| Rate for Payer: Zelis Auto |
$203.53
|
| Rate for Payer: Zelis Worker's Compensation |
$138.91
|
|
|
99215 ESTB PT HIGH MDM AT LEAST 40 MINS
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
8799215
|
|
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
|
|
|
99215 ESTB PT HIGH MDM AT LEAST 40 MINS
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
9299215
|
|
Hospital Revenue Code
|
519
|
| 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
|
|
|
99215 ESTB PT HIGH MDM AT LEAST 40 MINS
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
9599215
|
|
Hospital Revenue Code
|
521
|
| 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
|
|
|
99215 ESTB PT HIGH MDM AT LEAST 40 MINS
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
9699215
|
|
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
|
|
|
99215 ESTB PT HIGH MDM AT LEAST 40 MINS
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
8999215
|
|
Hospital Revenue Code
|
519
|
| 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
|
|
|
99215 ESTB PT HIGH MDM AT LEAST 40 MINS
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
8299215
|
|
Hospital Revenue Code
|
519
|
| 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
|
|
|
99215 ESTB PT HIGH MDM AT LEAST 40 MINS
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
8899215
|
|
Hospital Revenue Code
|
519
|
| 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
|
|
