|
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
|
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 HIGH COMPLEXITY
|
Professional
|
Both
|
$340.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
14099215
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$46.61 |
| Max. Negotiated Rate |
$323.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$141.46
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$116.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$141.46
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$154.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$136.13
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cigna Commercial |
$204.00
|
| Rate for Payer: Cimarron Advantage Cimarron Advantage PPO |
$190.58
|
| Rate for Payer: First Health Workers Compensation |
$315.61
|
| Rate for Payer: GEHA Commercial |
$136.13
|
| Rate for Payer: GEHA Medicare |
$136.13
|
| Rate for Payer: Health Net Federal Services Government |
$136.13
|
| Rate for Payer: HealthSmart Commercial |
$190.58
|
| Rate for Payer: HealthSmart Worker's Compensation |
$302.86
|
| Rate for Payer: Humana ChoiceCare |
$149.74
|
| Rate for Payer: Humana Medicare Advantage |
$136.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$190.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$154.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$136.13
|
| Rate for Payer: Multiplan All |
$255.00
|
| Rate for Payer: National Preferred Provider Network Commercial |
$323.00
|
| Rate for Payer: National Preferred Provider Network Worker's Compensation |
$318.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.94
|
| Rate for Payer: OMNI Networks Commercial |
$238.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$111.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$46.61
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$143.82
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$295.40
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$133.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$111.26
|
| Rate for Payer: Zelis Medicare |
$115.71
|
| Rate for Payer: Zelis Worker's Compensation |
$223.16
|
|
|
99215 HIGH COMPLEXITY
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
8699215
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$109.50 |
| Max. Negotiated Rate |
$416.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$262.80
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cigna Commercial |
$372.30
|
| Rate for Payer: First Health Commercial |
$394.20
|
| Rate for Payer: First Health Workers Compensation |
$169.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$394.20
|
| Rate for Payer: GEHA Commercial |
$350.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$394.20
|
| Rate for Payer: Humana ChoiceCare |
$113.88
|
| Rate for Payer: Multiplan All |
$398.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$262.80
|
| Rate for Payer: OMNI Networks Commercial |
$306.60
|
| Rate for Payer: One Health Plan PPO/POS |
$394.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$416.10
|
| Rate for Payer: Three Rivers Provider Network All |
$328.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$385.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$109.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$407.34
|
| Rate for Payer: Zelis Auto |
$175.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$219.00
|
| Rate for Payer: Zelis Worker's Compensation |
$119.57
|
|
|
99215 HIGH COMPLEXITY
|
Professional
|
Both
|
$340.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
12099215
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$46.61 |
| Max. Negotiated Rate |
$323.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$141.46
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$116.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$141.46
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$154.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$136.13
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cigna Commercial |
$204.00
|
| Rate for Payer: Cimarron Advantage Cimarron Advantage PPO |
$190.58
|
| Rate for Payer: First Health Workers Compensation |
$315.61
|
| Rate for Payer: GEHA Commercial |
$136.13
|
| Rate for Payer: GEHA Medicare |
$136.13
|
| Rate for Payer: Health Net Federal Services Government |
$136.13
|
| Rate for Payer: HealthSmart Commercial |
$190.58
|
| Rate for Payer: HealthSmart Worker's Compensation |
$302.86
|
| Rate for Payer: Humana ChoiceCare |
$149.74
|
| Rate for Payer: Humana Medicare Advantage |
$136.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$190.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$154.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$136.13
|
| Rate for Payer: Multiplan All |
$255.00
|
| Rate for Payer: National Preferred Provider Network Commercial |
$323.00
|
| Rate for Payer: National Preferred Provider Network Worker's Compensation |
$318.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.94
|
| Rate for Payer: OMNI Networks Commercial |
$238.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$111.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$46.61
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$143.82
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$295.40
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$133.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$111.26
|
| Rate for Payer: Zelis Medicare |
$115.71
|
| Rate for Payer: Zelis Worker's Compensation |
$223.16
|
|
|
99215 HIGH COMPLEXITY
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
8699215
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$119.57 |
| Max. Negotiated Rate |
$416.10 |
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cigna Commercial |
$372.30
|
| Rate for Payer: First Health Commercial |
$394.20
|
| Rate for Payer: First Health Workers Compensation |
$169.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$394.20
|
| Rate for Payer: GEHA Commercial |
$306.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$394.20
|
| Rate for Payer: Multiplan All |
$398.58
|
| Rate for Payer: OMNI Networks Commercial |
$306.60
|
| Rate for Payer: One Health Plan PPO/POS |
$394.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$416.10
|
| Rate for Payer: Three Rivers Provider Network All |
$328.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$407.34
|
| Rate for Payer: Zelis Auto |
$175.20
|
| Rate for Payer: Zelis Worker's Compensation |
$119.57
|
|
|
99215 HIGH COMPLEXITY
|
Professional
|
Both
|
$340.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
11099215
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$46.61 |
| Max. Negotiated Rate |
$323.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$141.46
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$116.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$141.46
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$154.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$136.13
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cigna Commercial |
$204.00
|
| Rate for Payer: Cimarron Advantage Cimarron Advantage PPO |
$190.58
|
| Rate for Payer: First Health Workers Compensation |
$315.61
|
| Rate for Payer: GEHA Commercial |
$136.13
|
| Rate for Payer: GEHA Medicare |
$136.13
|
| Rate for Payer: Health Net Federal Services Government |
$136.13
|
| Rate for Payer: HealthSmart Commercial |
$190.58
|
| Rate for Payer: HealthSmart Worker's Compensation |
$302.86
|
| Rate for Payer: Humana ChoiceCare |
$149.74
|
| Rate for Payer: Humana Medicare Advantage |
$136.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$190.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$154.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$136.13
|
| Rate for Payer: Multiplan All |
$255.00
|
| Rate for Payer: National Preferred Provider Network Commercial |
$323.00
|
| Rate for Payer: National Preferred Provider Network Worker's Compensation |
$318.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.94
|
| Rate for Payer: OMNI Networks Commercial |
$238.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$111.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$46.61
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$143.82
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$295.40
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$133.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$111.26
|
| Rate for Payer: Zelis Medicare |
$115.71
|
| Rate for Payer: Zelis Worker's Compensation |
$223.16
|
|
|
99215 HIGH COMPLEXITY
|
Professional
|
Both
|
$340.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
10099215
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$46.61 |
| Max. Negotiated Rate |
$323.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$141.46
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$116.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$141.46
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$154.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$136.13
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cigna Commercial |
$204.00
|
| Rate for Payer: Cimarron Advantage Cimarron Advantage PPO |
$190.58
|
| Rate for Payer: First Health Workers Compensation |
$315.61
|
| Rate for Payer: GEHA Commercial |
$136.13
|
| Rate for Payer: GEHA Medicare |
$136.13
|
| Rate for Payer: Health Net Federal Services Government |
$136.13
|
| Rate for Payer: HealthSmart Commercial |
$190.58
|
| Rate for Payer: HealthSmart Worker's Compensation |
$302.86
|
| Rate for Payer: Humana ChoiceCare |
$149.74
|
| Rate for Payer: Humana Medicare Advantage |
$136.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$190.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$154.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$136.13
|
| Rate for Payer: Multiplan All |
$255.00
|
| Rate for Payer: National Preferred Provider Network Commercial |
$323.00
|
| Rate for Payer: National Preferred Provider Network Worker's Compensation |
$318.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.94
|
| Rate for Payer: OMNI Networks Commercial |
$238.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$111.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$46.61
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$143.82
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$295.40
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$133.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$111.26
|
| Rate for Payer: Zelis Medicare |
$115.71
|
| Rate for Payer: Zelis Worker's Compensation |
$223.16
|
|
|
99215 HIGH COMPLEXITY
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
23500030
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$109.50 |
| Max. Negotiated Rate |
$416.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$262.80
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cigna Commercial |
$372.30
|
| Rate for Payer: First Health Commercial |
$394.20
|
| Rate for Payer: First Health Workers Compensation |
$169.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$394.20
|
| Rate for Payer: GEHA Commercial |
$350.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$394.20
|
| Rate for Payer: Humana ChoiceCare |
$113.88
|
| Rate for Payer: Multiplan All |
$398.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$262.80
|
| Rate for Payer: OMNI Networks Commercial |
$306.60
|
| Rate for Payer: One Health Plan PPO/POS |
$394.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$416.10
|
| Rate for Payer: Three Rivers Provider Network All |
$328.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$385.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$109.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$407.34
|
| Rate for Payer: Zelis Auto |
$175.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$219.00
|
| Rate for Payer: Zelis Worker's Compensation |
$119.57
|
|
|
99215 HIGH COMPLEXITY
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
23500030
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$119.57 |
| Max. Negotiated Rate |
$416.10 |
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cigna Commercial |
$372.30
|
| Rate for Payer: First Health Commercial |
$394.20
|
| Rate for Payer: First Health Workers Compensation |
$169.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$394.20
|
| Rate for Payer: GEHA Commercial |
$306.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$394.20
|
| Rate for Payer: Multiplan All |
$398.58
|
| Rate for Payer: OMNI Networks Commercial |
$306.60
|
| Rate for Payer: One Health Plan PPO/POS |
$394.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$416.10
|
| Rate for Payer: Three Rivers Provider Network All |
$328.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$407.34
|
| Rate for Payer: Zelis Auto |
$175.20
|
| Rate for Payer: Zelis Worker's Compensation |
$119.57
|
|
|
99241 LEVEL 1 COMPLEXITY
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT 99241
|
| Hospital Charge Code |
21600351
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: First Health Commercial |
$172.80
|
| Rate for Payer: First Health Workers Compensation |
$74.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$172.80
|
| Rate for Payer: GEHA Commercial |
$153.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.80
|
| Rate for Payer: Humana ChoiceCare |
$49.92
|
| Rate for Payer: Multiplan All |
$174.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$115.20
|
| Rate for Payer: OMNI Networks Commercial |
$134.40
|
| Rate for Payer: One Health Plan PPO/POS |
$172.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$182.40
|
| Rate for Payer: Three Rivers Provider Network All |
$144.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$168.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$48.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$178.56
|
| Rate for Payer: Zelis Auto |
$76.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$96.00
|
| Rate for Payer: Zelis Worker's Compensation |
$52.42
|
|
|
99241 LEVEL 1 COMPLEXITY
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT 99241
|
| Hospital Charge Code |
21600351
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$52.42 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: First Health Commercial |
$172.80
|
| Rate for Payer: First Health Workers Compensation |
$74.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$172.80
|
| Rate for Payer: GEHA Commercial |
$134.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.80
|
| Rate for Payer: Multiplan All |
$174.72
|
| Rate for Payer: OMNI Networks Commercial |
$134.40
|
| Rate for Payer: One Health Plan PPO/POS |
$172.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$182.40
|
| Rate for Payer: Three Rivers Provider Network All |
$144.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$178.56
|
| Rate for Payer: Zelis Auto |
$76.80
|
| Rate for Payer: Zelis Worker's Compensation |
$52.42
|
|
|
99241 LEVEL 1 COMPLEXITY
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT 99241
|
| Hospital Charge Code |
9300022
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: First Health Commercial |
$172.80
|
| Rate for Payer: First Health Workers Compensation |
$74.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$172.80
|
| Rate for Payer: GEHA Commercial |
$153.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.80
|
| Rate for Payer: Humana ChoiceCare |
$49.92
|
| Rate for Payer: Multiplan All |
$174.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$115.20
|
| Rate for Payer: OMNI Networks Commercial |
$134.40
|
| Rate for Payer: One Health Plan PPO/POS |
$172.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$182.40
|
| Rate for Payer: Three Rivers Provider Network All |
$144.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$168.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$48.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$178.56
|
| Rate for Payer: Zelis Auto |
$76.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$96.00
|
| Rate for Payer: Zelis Worker's Compensation |
$52.42
|
|
|
99241 LEVEL 1 COMPLEXITY
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT 99241
|
| Hospital Charge Code |
9300022
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$52.42 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: First Health Commercial |
$172.80
|
| Rate for Payer: First Health Workers Compensation |
$74.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$172.80
|
| Rate for Payer: GEHA Commercial |
$134.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.80
|
| Rate for Payer: Multiplan All |
$174.72
|
| Rate for Payer: OMNI Networks Commercial |
$134.40
|
| Rate for Payer: One Health Plan PPO/POS |
$172.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$182.40
|
| Rate for Payer: Three Rivers Provider Network All |
$144.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$178.56
|
| Rate for Payer: Zelis Auto |
$76.80
|
| Rate for Payer: Zelis Worker's Compensation |
$52.42
|
|
|
99241 LEVEL 1 COMPLEXITY
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT 99241
|
| Hospital Charge Code |
8599241
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: First Health Commercial |
$172.80
|
| Rate for Payer: First Health Workers Compensation |
$74.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$172.80
|
| Rate for Payer: GEHA Commercial |
$153.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.80
|
| Rate for Payer: Humana ChoiceCare |
$49.92
|
| Rate for Payer: Multiplan All |
$174.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$115.20
|
| Rate for Payer: OMNI Networks Commercial |
$134.40
|
| Rate for Payer: One Health Plan PPO/POS |
$172.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$182.40
|
| Rate for Payer: Three Rivers Provider Network All |
$144.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$168.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$48.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$178.56
|
| Rate for Payer: Zelis Auto |
$76.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$96.00
|
| Rate for Payer: Zelis Worker's Compensation |
$52.42
|
|
|
99241 LEVEL 1 COMPLEXITY
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT 99241
|
| Hospital Charge Code |
8599241
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$52.42 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: First Health Commercial |
$172.80
|
| Rate for Payer: First Health Workers Compensation |
$74.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$172.80
|
| Rate for Payer: GEHA Commercial |
$134.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.80
|
| Rate for Payer: Multiplan All |
$174.72
|
| Rate for Payer: OMNI Networks Commercial |
$134.40
|
| Rate for Payer: One Health Plan PPO/POS |
$172.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$182.40
|
| Rate for Payer: Three Rivers Provider Network All |
$144.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$178.56
|
| Rate for Payer: Zelis Auto |
$76.80
|
| Rate for Payer: Zelis Worker's Compensation |
$52.42
|
|
|
99241 OFFICE CONSULTATION NEW/ESTAB PT
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT 99241
|
| Hospital Charge Code |
21900141
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$52.42 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: First Health Commercial |
$172.80
|
| Rate for Payer: First Health Workers Compensation |
$74.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$172.80
|
| Rate for Payer: GEHA Commercial |
$134.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.80
|
| Rate for Payer: Multiplan All |
$174.72
|
| Rate for Payer: OMNI Networks Commercial |
$134.40
|
| Rate for Payer: One Health Plan PPO/POS |
$172.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$182.40
|
| Rate for Payer: Three Rivers Provider Network All |
$144.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$178.56
|
| Rate for Payer: Zelis Auto |
$76.80
|
| Rate for Payer: Zelis Worker's Compensation |
$52.42
|
|
|
99241 OFFICE CONSULTATION NEW/ESTAB PT
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT 99241
|
| Hospital Charge Code |
21700032
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$52.42 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: First Health Commercial |
$172.80
|
| Rate for Payer: First Health Workers Compensation |
$74.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$172.80
|
| Rate for Payer: GEHA Commercial |
$134.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.80
|
| Rate for Payer: Multiplan All |
$174.72
|
| Rate for Payer: OMNI Networks Commercial |
$134.40
|
| Rate for Payer: One Health Plan PPO/POS |
$172.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$182.40
|
| Rate for Payer: Three Rivers Provider Network All |
$144.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$178.56
|
| Rate for Payer: Zelis Auto |
$76.80
|
| Rate for Payer: Zelis Worker's Compensation |
$52.42
|
|
|
99241 OFFICE CONSULTATION NEW/ESTAB PT
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT 99241
|
| Hospital Charge Code |
21900141
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: First Health Commercial |
$172.80
|
| Rate for Payer: First Health Workers Compensation |
$74.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$172.80
|
| Rate for Payer: GEHA Commercial |
$153.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.80
|
| Rate for Payer: Humana ChoiceCare |
$49.92
|
| Rate for Payer: Multiplan All |
$174.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$115.20
|
| Rate for Payer: OMNI Networks Commercial |
$134.40
|
| Rate for Payer: One Health Plan PPO/POS |
$172.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$182.40
|
| Rate for Payer: Three Rivers Provider Network All |
$144.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$168.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$48.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$178.56
|
| Rate for Payer: Zelis Auto |
$76.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$96.00
|
| Rate for Payer: Zelis Worker's Compensation |
$52.42
|
|
|
99241 OFFICE CONSULTATION NEW/ESTAB PT
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT 99241
|
| Hospital Charge Code |
21700032
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: First Health Commercial |
$172.80
|
| Rate for Payer: First Health Workers Compensation |
$74.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$172.80
|
| Rate for Payer: GEHA Commercial |
$153.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.80
|
| Rate for Payer: Humana ChoiceCare |
$49.92
|
| Rate for Payer: Multiplan All |
$174.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$115.20
|
| Rate for Payer: OMNI Networks Commercial |
$134.40
|
| Rate for Payer: One Health Plan PPO/POS |
$172.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$182.40
|
| Rate for Payer: Three Rivers Provider Network All |
$144.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$168.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$48.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$178.56
|
| Rate for Payer: Zelis Auto |
$76.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$96.00
|
| Rate for Payer: Zelis Worker's Compensation |
$52.42
|
|
|
99241 OFFICE CONSULT NEW/ESTAB PAT 15 MI
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT 99241
|
| Hospital Charge Code |
21999241
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: First Health Commercial |
$172.80
|
| Rate for Payer: First Health Workers Compensation |
$74.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$172.80
|
| Rate for Payer: GEHA Commercial |
$153.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.80
|
| Rate for Payer: Humana ChoiceCare |
$49.92
|
| Rate for Payer: Multiplan All |
$174.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$115.20
|
| Rate for Payer: OMNI Networks Commercial |
$134.40
|
| Rate for Payer: One Health Plan PPO/POS |
$172.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$182.40
|
| Rate for Payer: Three Rivers Provider Network All |
$144.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$168.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$48.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$178.56
|
| Rate for Payer: Zelis Auto |
$76.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$96.00
|
| Rate for Payer: Zelis Worker's Compensation |
$52.42
|
|
|
99241 OFFICE CONSULT NEW/ESTAB PAT 15 MI
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT 99241
|
| Hospital Charge Code |
21999241
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$52.42 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: First Health Commercial |
$172.80
|
| Rate for Payer: First Health Workers Compensation |
$74.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$172.80
|
| Rate for Payer: GEHA Commercial |
$134.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.80
|
| Rate for Payer: Multiplan All |
$174.72
|
| Rate for Payer: OMNI Networks Commercial |
$134.40
|
| Rate for Payer: One Health Plan PPO/POS |
$172.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$182.40
|
| Rate for Payer: Three Rivers Provider Network All |
$144.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$178.56
|
| Rate for Payer: Zelis Auto |
$76.80
|
| Rate for Payer: Zelis Worker's Compensation |
$52.42
|
|
|
99241 OFFICE CONSULT NEW/ESTAB PT 15
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT 99241
|
| Hospital Charge Code |
21599241
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$52.42 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: First Health Commercial |
$172.80
|
| Rate for Payer: First Health Workers Compensation |
$74.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$172.80
|
| Rate for Payer: GEHA Commercial |
$134.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.80
|
| Rate for Payer: Multiplan All |
$174.72
|
| Rate for Payer: OMNI Networks Commercial |
$134.40
|
| Rate for Payer: One Health Plan PPO/POS |
$172.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$182.40
|
| Rate for Payer: Three Rivers Provider Network All |
$144.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$178.56
|
| Rate for Payer: Zelis Auto |
$76.80
|
| Rate for Payer: Zelis Worker's Compensation |
$52.42
|
|
|
99241 OFFICE CONSULT NEW/ESTAB PT 15
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT 99241
|
| Hospital Charge Code |
25500059
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$52.42 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: First Health Commercial |
$172.80
|
| Rate for Payer: First Health Workers Compensation |
$74.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$172.80
|
| Rate for Payer: GEHA Commercial |
$134.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.80
|
| Rate for Payer: Multiplan All |
$174.72
|
| Rate for Payer: OMNI Networks Commercial |
$134.40
|
| Rate for Payer: One Health Plan PPO/POS |
$172.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$182.40
|
| Rate for Payer: Three Rivers Provider Network All |
$144.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$178.56
|
| Rate for Payer: Zelis Auto |
$76.80
|
| Rate for Payer: Zelis Worker's Compensation |
$52.42
|
|
|
99241 OFFICE CONSULT NEW/ESTAB PT 15
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT 99241
|
| Hospital Charge Code |
21600059
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$52.42 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: First Health Commercial |
$172.80
|
| Rate for Payer: First Health Workers Compensation |
$74.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$172.80
|
| Rate for Payer: GEHA Commercial |
$134.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.80
|
| Rate for Payer: Multiplan All |
$174.72
|
| Rate for Payer: OMNI Networks Commercial |
$134.40
|
| Rate for Payer: One Health Plan PPO/POS |
$172.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$182.40
|
| Rate for Payer: Three Rivers Provider Network All |
$144.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$178.56
|
| Rate for Payer: Zelis Auto |
$76.80
|
| Rate for Payer: Zelis Worker's Compensation |
$52.42
|
|
