|
99241 OFFICE CONSULT NEW/ESTAB PT 15
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT 99241
|
| Hospital Charge Code |
9399241
|
|
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 OFFICE CONSULT NEW/ESTAB PT 15
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT 99241
|
| Hospital Charge Code |
25500059
|
|
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 PT 15
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT 99241
|
| Hospital Charge Code |
9399241
|
|
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 OFFICE CONSULT NEW/ESTAB PT 15
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT 99241
|
| Hospital Charge Code |
21600059
|
|
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 OFFICE CONSULT NEW/ESTAB PT 15
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT 99241
|
| Hospital Charge Code |
21599241
|
|
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
|
|
|
99242 OFF/OP CNSLTJ NEW/EST PT SF MD
|
Facility
|
OP
|
$104.79
|
|
|
Service Code
|
CPT 99242
|
| Hospital Charge Code |
7299242
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$26.20 |
| Max. Negotiated Rate |
$99.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$62.87
|
| Rate for Payer: Cash Price |
$62.87
|
| Rate for Payer: Cigna Commercial |
$89.07
|
| Rate for Payer: First Health Commercial |
$94.31
|
| Rate for Payer: First Health Workers Compensation |
$40.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$94.31
|
| Rate for Payer: GEHA Commercial |
$83.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$94.31
|
| Rate for Payer: Humana ChoiceCare |
$27.25
|
| Rate for Payer: Multiplan All |
$95.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$62.87
|
| Rate for Payer: OMNI Networks Commercial |
$73.35
|
| Rate for Payer: One Health Plan PPO/POS |
$94.31
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$99.55
|
| Rate for Payer: Three Rivers Provider Network All |
$78.59
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$92.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$26.20
|
| Rate for Payer: United Payors & United Providers UP&UP |
$97.45
|
| Rate for Payer: Zelis Auto |
$41.92
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$52.40
|
| Rate for Payer: Zelis Worker's Compensation |
$28.61
|
|
|
99242 OFF/OP CNSLTJ NEW/EST PT SF MD
|
Facility
|
IP
|
$104.79
|
|
|
Service Code
|
CPT 99242
|
| Hospital Charge Code |
7299242
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$28.61 |
| Max. Negotiated Rate |
$99.55 |
| Rate for Payer: Cash Price |
$62.87
|
| Rate for Payer: Cigna Commercial |
$89.07
|
| Rate for Payer: First Health Commercial |
$94.31
|
| Rate for Payer: First Health Workers Compensation |
$40.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$94.31
|
| Rate for Payer: GEHA Commercial |
$73.35
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$94.31
|
| Rate for Payer: Multiplan All |
$95.36
|
| Rate for Payer: OMNI Networks Commercial |
$73.35
|
| Rate for Payer: One Health Plan PPO/POS |
$94.31
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$99.55
|
| Rate for Payer: Three Rivers Provider Network All |
$78.59
|
| Rate for Payer: United Payors & United Providers UP&UP |
$97.45
|
| Rate for Payer: Zelis Auto |
$41.92
|
| Rate for Payer: Zelis Worker's Compensation |
$28.61
|
|
|
99318 ANNUAL NURSING FAC ASSESS
|
Facility
|
IP
|
$291.00
|
|
|
Service Code
|
CPT 99318
|
| Hospital Charge Code |
9400072
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$79.44 |
| Max. Negotiated Rate |
$276.45 |
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cigna Commercial |
$247.35
|
| Rate for Payer: First Health Commercial |
$261.90
|
| Rate for Payer: First Health Workers Compensation |
$112.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$261.90
|
| Rate for Payer: GEHA Commercial |
$203.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$261.90
|
| Rate for Payer: Multiplan All |
$264.81
|
| Rate for Payer: OMNI Networks Commercial |
$203.70
|
| Rate for Payer: One Health Plan PPO/POS |
$261.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$276.45
|
| Rate for Payer: Three Rivers Provider Network All |
$218.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$270.63
|
| Rate for Payer: Zelis Auto |
$116.40
|
| Rate for Payer: Zelis Worker's Compensation |
$79.44
|
|
|
99318 ANNUAL NURSING FAC ASSESS
|
Facility
|
OP
|
$291.00
|
|
|
Service Code
|
CPT 99318
|
| Hospital Charge Code |
9400072
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$72.75 |
| Max. Negotiated Rate |
$276.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$174.60
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cigna Commercial |
$247.35
|
| Rate for Payer: First Health Commercial |
$261.90
|
| Rate for Payer: First Health Workers Compensation |
$112.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$261.90
|
| Rate for Payer: GEHA Commercial |
$232.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$261.90
|
| Rate for Payer: Humana ChoiceCare |
$75.66
|
| Rate for Payer: Multiplan All |
$264.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$174.60
|
| Rate for Payer: OMNI Networks Commercial |
$203.70
|
| Rate for Payer: One Health Plan PPO/POS |
$261.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$276.45
|
| Rate for Payer: Three Rivers Provider Network All |
$218.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$256.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$72.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$270.63
|
| Rate for Payer: Zelis Auto |
$116.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$145.50
|
| Rate for Payer: Zelis Worker's Compensation |
$79.44
|
|
|
99354 PROLONGED 30-74 MIN
|
Facility
|
OP
|
$289.00
|
|
|
Service Code
|
CPT 99354
|
| Hospital Charge Code |
21600064
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$72.25 |
| Max. Negotiated Rate |
$274.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$173.40
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cigna Commercial |
$245.65
|
| Rate for Payer: First Health Commercial |
$260.10
|
| Rate for Payer: First Health Workers Compensation |
$111.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$260.10
|
| Rate for Payer: GEHA Commercial |
$231.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$260.10
|
| Rate for Payer: Humana ChoiceCare |
$75.14
|
| Rate for Payer: Multiplan All |
$262.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$173.40
|
| Rate for Payer: OMNI Networks Commercial |
$202.30
|
| Rate for Payer: One Health Plan PPO/POS |
$260.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$274.55
|
| Rate for Payer: Three Rivers Provider Network All |
$216.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$254.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$72.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$268.77
|
| Rate for Payer: Zelis Auto |
$115.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$144.50
|
| Rate for Payer: Zelis Worker's Compensation |
$78.90
|
|
|
99354 PROLONGED 30-74 MIN
|
Facility
|
IP
|
$289.00
|
|
|
Service Code
|
CPT 99354
|
| Hospital Charge Code |
21599354
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$78.90 |
| Max. Negotiated Rate |
$274.55 |
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cigna Commercial |
$245.65
|
| Rate for Payer: First Health Commercial |
$260.10
|
| Rate for Payer: First Health Workers Compensation |
$111.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$260.10
|
| Rate for Payer: GEHA Commercial |
$202.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$260.10
|
| Rate for Payer: Multiplan All |
$262.99
|
| Rate for Payer: OMNI Networks Commercial |
$202.30
|
| Rate for Payer: One Health Plan PPO/POS |
$260.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$274.55
|
| Rate for Payer: Three Rivers Provider Network All |
$216.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$268.77
|
| Rate for Payer: Zelis Auto |
$115.60
|
| Rate for Payer: Zelis Worker's Compensation |
$78.90
|
|
|
99354 PROLONGED 30-74 MIN
|
Facility
|
IP
|
$289.00
|
|
|
Service Code
|
CPT 99354
|
| Hospital Charge Code |
21600064
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$78.90 |
| Max. Negotiated Rate |
$274.55 |
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cigna Commercial |
$245.65
|
| Rate for Payer: First Health Commercial |
$260.10
|
| Rate for Payer: First Health Workers Compensation |
$111.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$260.10
|
| Rate for Payer: GEHA Commercial |
$202.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$260.10
|
| Rate for Payer: Multiplan All |
$262.99
|
| Rate for Payer: OMNI Networks Commercial |
$202.30
|
| Rate for Payer: One Health Plan PPO/POS |
$260.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$274.55
|
| Rate for Payer: Three Rivers Provider Network All |
$216.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$268.77
|
| Rate for Payer: Zelis Auto |
$115.60
|
| Rate for Payer: Zelis Worker's Compensation |
$78.90
|
|
|
99354 PROLONGED 30-74 MIN
|
Facility
|
IP
|
$289.00
|
|
|
Service Code
|
CPT 99354
|
| Hospital Charge Code |
25500064
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$78.90 |
| Max. Negotiated Rate |
$274.55 |
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cigna Commercial |
$245.65
|
| Rate for Payer: First Health Commercial |
$260.10
|
| Rate for Payer: First Health Workers Compensation |
$111.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$260.10
|
| Rate for Payer: GEHA Commercial |
$202.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$260.10
|
| Rate for Payer: Multiplan All |
$262.99
|
| Rate for Payer: OMNI Networks Commercial |
$202.30
|
| Rate for Payer: One Health Plan PPO/POS |
$260.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$274.55
|
| Rate for Payer: Three Rivers Provider Network All |
$216.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$268.77
|
| Rate for Payer: Zelis Auto |
$115.60
|
| Rate for Payer: Zelis Worker's Compensation |
$78.90
|
|
|
99354 PROLONGED 30-74 MIN
|
Facility
|
OP
|
$289.00
|
|
|
Service Code
|
CPT 99354
|
| Hospital Charge Code |
21599354
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$72.25 |
| Max. Negotiated Rate |
$274.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$173.40
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cigna Commercial |
$245.65
|
| Rate for Payer: First Health Commercial |
$260.10
|
| Rate for Payer: First Health Workers Compensation |
$111.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$260.10
|
| Rate for Payer: GEHA Commercial |
$231.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$260.10
|
| Rate for Payer: Humana ChoiceCare |
$75.14
|
| Rate for Payer: Multiplan All |
$262.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$173.40
|
| Rate for Payer: OMNI Networks Commercial |
$202.30
|
| Rate for Payer: One Health Plan PPO/POS |
$260.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$274.55
|
| Rate for Payer: Three Rivers Provider Network All |
$216.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$254.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$72.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$268.77
|
| Rate for Payer: Zelis Auto |
$115.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$144.50
|
| Rate for Payer: Zelis Worker's Compensation |
$78.90
|
|
|
99354 PROLONGED 30-74 MIN
|
Facility
|
OP
|
$289.00
|
|
|
Service Code
|
CPT 99354
|
| Hospital Charge Code |
25500064
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$72.25 |
| Max. Negotiated Rate |
$274.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$173.40
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cigna Commercial |
$245.65
|
| Rate for Payer: First Health Commercial |
$260.10
|
| Rate for Payer: First Health Workers Compensation |
$111.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$260.10
|
| Rate for Payer: GEHA Commercial |
$231.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$260.10
|
| Rate for Payer: Humana ChoiceCare |
$75.14
|
| Rate for Payer: Multiplan All |
$262.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$173.40
|
| Rate for Payer: OMNI Networks Commercial |
$202.30
|
| Rate for Payer: One Health Plan PPO/POS |
$260.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$274.55
|
| Rate for Payer: Three Rivers Provider Network All |
$216.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$254.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$72.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$268.77
|
| Rate for Payer: Zelis Auto |
$115.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$144.50
|
| Rate for Payer: Zelis Worker's Compensation |
$78.90
|
|
|
99355 PROLONGED SERVICE, OFFICE
|
Facility
|
IP
|
$279.00
|
|
|
Service Code
|
CPT 99355
|
| Hospital Charge Code |
9000021
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$76.17 |
| Max. Negotiated Rate |
$265.05 |
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Cigna Commercial |
$237.15
|
| Rate for Payer: First Health Commercial |
$251.10
|
| Rate for Payer: First Health Workers Compensation |
$107.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$251.10
|
| Rate for Payer: GEHA Commercial |
$195.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$251.10
|
| Rate for Payer: Multiplan All |
$253.89
|
| Rate for Payer: OMNI Networks Commercial |
$195.30
|
| Rate for Payer: One Health Plan PPO/POS |
$251.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$265.05
|
| Rate for Payer: Three Rivers Provider Network All |
$209.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$259.47
|
| Rate for Payer: Zelis Auto |
$111.60
|
| Rate for Payer: Zelis Worker's Compensation |
$76.17
|
|
|
99355 PROLONGED SERVICE, OFFICE
|
Facility
|
OP
|
$279.00
|
|
|
Service Code
|
CPT 99355
|
| Hospital Charge Code |
9000021
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$69.75 |
| Max. Negotiated Rate |
$265.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$167.40
|
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Cigna Commercial |
$237.15
|
| Rate for Payer: First Health Commercial |
$251.10
|
| Rate for Payer: First Health Workers Compensation |
$107.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$251.10
|
| Rate for Payer: GEHA Commercial |
$223.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$251.10
|
| Rate for Payer: Humana ChoiceCare |
$72.54
|
| Rate for Payer: Multiplan All |
$253.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$167.40
|
| Rate for Payer: OMNI Networks Commercial |
$195.30
|
| Rate for Payer: One Health Plan PPO/POS |
$251.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$265.05
|
| Rate for Payer: Three Rivers Provider Network All |
$209.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$245.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$69.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$259.47
|
| Rate for Payer: Zelis Auto |
$111.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$139.50
|
| Rate for Payer: Zelis Worker's Compensation |
$76.17
|
|
|
99381 INITIAL PREVENT MED NEW PT 0-1YR
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
CPT 99381
|
| Hospital Charge Code |
21799455
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$51.74 |
| Max. Negotiated Rate |
$189.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$119.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$134.80
|
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cigna Commercial |
$169.15
|
| Rate for Payer: First Health Commercial |
$179.10
|
| Rate for Payer: First Health Workers Compensation |
$76.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$179.10
|
| Rate for Payer: GEHA Commercial |
$159.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$179.10
|
| Rate for Payer: Humana ChoiceCare |
$51.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$137.55
|
| Rate for Payer: Multiplan All |
$181.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$119.40
|
| Rate for Payer: OMNI Networks Commercial |
$139.30
|
| Rate for Payer: One Health Plan PPO/POS |
$179.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$158.82
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$137.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$189.05
|
| Rate for Payer: Three Rivers Provider Network All |
$149.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$175.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$137.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$185.07
|
| Rate for Payer: Zelis Auto |
$79.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$99.50
|
| Rate for Payer: Zelis Worker's Compensation |
$54.33
|
|
|
99381 INITIAL PREVENT MED NEW PT 0-1YR
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
CPT 99381
|
| Hospital Charge Code |
21999381
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.33 |
| Max. Negotiated Rate |
$189.05 |
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cigna Commercial |
$169.15
|
| Rate for Payer: First Health Commercial |
$179.10
|
| Rate for Payer: First Health Workers Compensation |
$76.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$179.10
|
| Rate for Payer: GEHA Commercial |
$139.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$179.10
|
| Rate for Payer: Multiplan All |
$181.09
|
| Rate for Payer: OMNI Networks Commercial |
$139.30
|
| Rate for Payer: One Health Plan PPO/POS |
$179.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$189.05
|
| Rate for Payer: Three Rivers Provider Network All |
$149.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$185.07
|
| Rate for Payer: Zelis Auto |
$79.60
|
| Rate for Payer: Zelis Worker's Compensation |
$54.33
|
|
|
99381 INITIAL PREVENT MED NEW PT 0-1YR
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
CPT 99381
|
| Hospital Charge Code |
21999381
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$51.74 |
| Max. Negotiated Rate |
$189.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$119.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$134.80
|
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cigna Commercial |
$169.15
|
| Rate for Payer: First Health Commercial |
$179.10
|
| Rate for Payer: First Health Workers Compensation |
$76.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$179.10
|
| Rate for Payer: GEHA Commercial |
$159.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$179.10
|
| Rate for Payer: Humana ChoiceCare |
$51.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$137.55
|
| Rate for Payer: Multiplan All |
$181.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$119.40
|
| Rate for Payer: OMNI Networks Commercial |
$139.30
|
| Rate for Payer: One Health Plan PPO/POS |
$179.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$158.82
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$137.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$189.05
|
| Rate for Payer: Three Rivers Provider Network All |
$149.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$175.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$137.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$185.07
|
| Rate for Payer: Zelis Auto |
$79.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$99.50
|
| Rate for Payer: Zelis Worker's Compensation |
$54.33
|
|
|
99381 INITIAL PREVENT MED NEW PT 0-1YR
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
CPT 99381
|
| Hospital Charge Code |
21799455
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.33 |
| Max. Negotiated Rate |
$189.05 |
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cigna Commercial |
$169.15
|
| Rate for Payer: First Health Commercial |
$179.10
|
| Rate for Payer: First Health Workers Compensation |
$76.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$179.10
|
| Rate for Payer: GEHA Commercial |
$139.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$179.10
|
| Rate for Payer: Multiplan All |
$181.09
|
| Rate for Payer: OMNI Networks Commercial |
$139.30
|
| Rate for Payer: One Health Plan PPO/POS |
$179.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$189.05
|
| Rate for Payer: Three Rivers Provider Network All |
$149.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$185.07
|
| Rate for Payer: Zelis Auto |
$79.60
|
| Rate for Payer: Zelis Worker's Compensation |
$54.33
|
|
|
99381 PREVENTIVE MED NEW PATIENT 0-1YR
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
CPT 99381
|
| Hospital Charge Code |
21600065
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$51.74 |
| Max. Negotiated Rate |
$189.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$119.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$134.80
|
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cigna Commercial |
$169.15
|
| Rate for Payer: First Health Commercial |
$179.10
|
| Rate for Payer: First Health Workers Compensation |
$76.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$179.10
|
| Rate for Payer: GEHA Commercial |
$159.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$179.10
|
| Rate for Payer: Humana ChoiceCare |
$51.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$137.55
|
| Rate for Payer: Multiplan All |
$181.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$119.40
|
| Rate for Payer: OMNI Networks Commercial |
$139.30
|
| Rate for Payer: One Health Plan PPO/POS |
$179.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$158.82
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$137.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$189.05
|
| Rate for Payer: Three Rivers Provider Network All |
$149.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$175.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$137.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$185.07
|
| Rate for Payer: Zelis Auto |
$79.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$99.50
|
| Rate for Payer: Zelis Worker's Compensation |
$54.33
|
|
|
99381 PREVENTIVE MED NEW PATIENT 0-1YR
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
CPT 99381
|
| Hospital Charge Code |
21600065
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$54.33 |
| Max. Negotiated Rate |
$189.05 |
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cigna Commercial |
$169.15
|
| Rate for Payer: First Health Commercial |
$179.10
|
| Rate for Payer: First Health Workers Compensation |
$76.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$179.10
|
| Rate for Payer: GEHA Commercial |
$139.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$179.10
|
| Rate for Payer: Multiplan All |
$181.09
|
| Rate for Payer: OMNI Networks Commercial |
$139.30
|
| Rate for Payer: One Health Plan PPO/POS |
$179.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$189.05
|
| Rate for Payer: Three Rivers Provider Network All |
$149.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$185.07
|
| Rate for Payer: Zelis Auto |
$79.60
|
| Rate for Payer: Zelis Worker's Compensation |
$54.33
|
|
|
99381 PREVENTIVE MED NEW PATIENT 0-1YR
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
CPT 99381
|
| Hospital Charge Code |
25500065
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.33 |
| Max. Negotiated Rate |
$189.05 |
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cigna Commercial |
$169.15
|
| Rate for Payer: First Health Commercial |
$179.10
|
| Rate for Payer: First Health Workers Compensation |
$76.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$179.10
|
| Rate for Payer: GEHA Commercial |
$139.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$179.10
|
| Rate for Payer: Multiplan All |
$181.09
|
| Rate for Payer: OMNI Networks Commercial |
$139.30
|
| Rate for Payer: One Health Plan PPO/POS |
$179.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$189.05
|
| Rate for Payer: Three Rivers Provider Network All |
$149.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$185.07
|
| Rate for Payer: Zelis Auto |
$79.60
|
| Rate for Payer: Zelis Worker's Compensation |
$54.33
|
|
|
99381 PREVENTIVE MED NEW PATIENT 0-1YR
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
CPT 99381
|
| Hospital Charge Code |
25500065
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$51.74 |
| Max. Negotiated Rate |
$189.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$119.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$134.80
|
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cigna Commercial |
$169.15
|
| Rate for Payer: First Health Commercial |
$179.10
|
| Rate for Payer: First Health Workers Compensation |
$76.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$179.10
|
| Rate for Payer: GEHA Commercial |
$159.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$179.10
|
| Rate for Payer: Humana ChoiceCare |
$51.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$137.55
|
| Rate for Payer: Multiplan All |
$181.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$119.40
|
| Rate for Payer: OMNI Networks Commercial |
$139.30
|
| Rate for Payer: One Health Plan PPO/POS |
$179.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$158.82
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$137.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$189.05
|
| Rate for Payer: Three Rivers Provider Network All |
$149.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$175.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$137.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$185.07
|
| Rate for Payer: Zelis Auto |
$79.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$99.50
|
| Rate for Payer: Zelis Worker's Compensation |
$54.33
|
|
