|
HOLTER MONITOR-REC-CONN&DISC UPTO 48 HR
|
Facility
|
OP
|
$1,215.00
|
|
|
Service Code
|
CPT 93225
|
| Hospital Charge Code |
4000025
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$93.21 |
| Max. Negotiated Rate |
$1,154.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$117.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$729.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$117.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$93.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Cigna Commercial |
$1,032.75
|
| Rate for Payer: First Health Commercial |
$1,093.50
|
| Rate for Payer: First Health Workers Compensation |
$469.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,093.50
|
| Rate for Payer: GEHA Commercial |
$972.00
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,093.50
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$95.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$1,105.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$850.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,093.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$109.82
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$95.11
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,154.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$911.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Commercial |
$1,032.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$95.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,129.95
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$486.00
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$331.69
|
|
|
HOLTER MONITOR-REC-CONN&DISC UPTO 48 HR
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT 93225
|
| Hospital Charge Code |
8693225
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$20.20 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$117.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$44.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$117.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$93.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$62.90
|
| Rate for Payer: First Health Commercial |
$66.60
|
| Rate for Payer: First Health Workers Compensation |
$28.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$66.60
|
| Rate for Payer: GEHA Commercial |
$59.20
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$66.60
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$95.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$67.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$51.80
|
| Rate for Payer: One Health Plan PPO/POS |
$66.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$109.82
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$95.11
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$70.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$55.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Commercial |
$62.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$95.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$68.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$29.60
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$20.20
|
|
|
HOLTER MONITOR-REC-CONN&DISC UPTO 48 HR
|
Facility
|
IP
|
$1,215.00
|
|
|
Service Code
|
CPT 93225
|
| Hospital Charge Code |
4000025
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$331.69 |
| Max. Negotiated Rate |
$1,154.25 |
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Cigna Commercial |
$1,032.75
|
| Rate for Payer: First Health Commercial |
$1,093.50
|
| Rate for Payer: First Health Workers Compensation |
$469.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,093.50
|
| Rate for Payer: GEHA Commercial |
$850.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,093.50
|
| Rate for Payer: Multiplan All |
$1,105.65
|
| Rate for Payer: OMNI Networks Commercial |
$850.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,093.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,154.25
|
| Rate for Payer: Three Rivers Provider Network All |
$911.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,129.95
|
| Rate for Payer: Zelis Auto |
$486.00
|
| Rate for Payer: Zelis Worker's Compensation |
$331.69
|
|
|
HOME/RES VISIT EST PATIENT SF MDM 20 MIN
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 99347
|
| Hospital Charge Code |
8799347
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$47.23 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$66.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$121.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Worker's Compensation |
$47.23
|
|
|
HOME/RES VISIT EST PATIENT SF MDM 20 MIN
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 99347
|
| Hospital Charge Code |
9699347
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$43.25 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$103.80
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$66.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$138.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Humana ChoiceCare |
$44.98
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$103.80
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$152.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$43.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$86.50
|
| Rate for Payer: Zelis Worker's Compensation |
$47.23
|
|
|
HOME/RES VISIT EST PATIENT SF MDM 20 MIN
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 99347
|
| Hospital Charge Code |
8599347
|
|
Hospital Revenue Code
|
522
|
| Min. Negotiated Rate |
$43.25 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$103.80
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$66.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$138.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Humana ChoiceCare |
$44.98
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$103.80
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$152.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$43.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$86.50
|
| Rate for Payer: Zelis Worker's Compensation |
$47.23
|
|
|
HOME/RES VISIT EST PATIENT SF MDM 20 MIN
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 99347
|
| Hospital Charge Code |
8599347
|
|
Hospital Revenue Code
|
522
|
| Min. Negotiated Rate |
$47.23 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$66.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$121.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Worker's Compensation |
$47.23
|
|
|
HOME/RES VISIT EST PATIENT SF MDM 20 MIN
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 99347
|
| Hospital Charge Code |
8799347
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$43.25 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$103.80
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$66.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$138.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Humana ChoiceCare |
$44.98
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$103.80
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$152.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$43.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$86.50
|
| Rate for Payer: Zelis Worker's Compensation |
$47.23
|
|
|
HOME/RES VISIT EST PATIENT SF MDM 20 MIN
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 99347
|
| Hospital Charge Code |
9699347
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$47.23 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$66.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$121.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Worker's Compensation |
$47.23
|
|
|
HOME/RES VISIT EST PATNT HIGH MDM 60 MIN
|
Facility
|
OP
|
$543.00
|
|
|
Service Code
|
CPT 99350
|
| Hospital Charge Code |
9699350
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$135.75 |
| Max. Negotiated Rate |
$515.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$325.80
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cigna Commercial |
$461.55
|
| Rate for Payer: First Health Commercial |
$488.70
|
| Rate for Payer: First Health Workers Compensation |
$209.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$488.70
|
| Rate for Payer: GEHA Commercial |
$434.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$488.70
|
| Rate for Payer: Humana ChoiceCare |
$141.18
|
| Rate for Payer: Multiplan All |
$494.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$325.80
|
| Rate for Payer: OMNI Networks Commercial |
$380.10
|
| Rate for Payer: One Health Plan PPO/POS |
$488.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$515.85
|
| Rate for Payer: Three Rivers Provider Network All |
$407.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$477.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$504.99
|
| Rate for Payer: Zelis Auto |
$217.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$271.50
|
| Rate for Payer: Zelis Worker's Compensation |
$148.24
|
|
|
HOME/RES VISIT EST PATNT HIGH MDM 60 MIN
|
Facility
|
OP
|
$543.00
|
|
|
Service Code
|
CPT 99350
|
| Hospital Charge Code |
8599350
|
|
Hospital Revenue Code
|
522
|
| Min. Negotiated Rate |
$135.75 |
| Max. Negotiated Rate |
$515.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$325.80
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cigna Commercial |
$461.55
|
| Rate for Payer: First Health Commercial |
$488.70
|
| Rate for Payer: First Health Workers Compensation |
$209.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$488.70
|
| Rate for Payer: GEHA Commercial |
$434.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$488.70
|
| Rate for Payer: Humana ChoiceCare |
$141.18
|
| Rate for Payer: Multiplan All |
$494.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$325.80
|
| Rate for Payer: OMNI Networks Commercial |
$380.10
|
| Rate for Payer: One Health Plan PPO/POS |
$488.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$515.85
|
| Rate for Payer: Three Rivers Provider Network All |
$407.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$477.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$504.99
|
| Rate for Payer: Zelis Auto |
$217.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$271.50
|
| Rate for Payer: Zelis Worker's Compensation |
$148.24
|
|
|
HOME/RES VISIT EST PATNT HIGH MDM 60 MIN
|
Facility
|
IP
|
$543.00
|
|
|
Service Code
|
CPT 99350
|
| Hospital Charge Code |
8799350
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$148.24 |
| Max. Negotiated Rate |
$515.85 |
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cigna Commercial |
$461.55
|
| Rate for Payer: First Health Commercial |
$488.70
|
| Rate for Payer: First Health Workers Compensation |
$209.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$488.70
|
| Rate for Payer: GEHA Commercial |
$380.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$488.70
|
| Rate for Payer: Multiplan All |
$494.13
|
| Rate for Payer: OMNI Networks Commercial |
$380.10
|
| Rate for Payer: One Health Plan PPO/POS |
$488.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$515.85
|
| Rate for Payer: Three Rivers Provider Network All |
$407.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$504.99
|
| Rate for Payer: Zelis Auto |
$217.20
|
| Rate for Payer: Zelis Worker's Compensation |
$148.24
|
|
|
HOME/RES VISIT EST PATNT HIGH MDM 60 MIN
|
Facility
|
OP
|
$543.00
|
|
|
Service Code
|
CPT 99350
|
| Hospital Charge Code |
8799350
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$135.75 |
| Max. Negotiated Rate |
$515.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$325.80
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cigna Commercial |
$461.55
|
| Rate for Payer: First Health Commercial |
$488.70
|
| Rate for Payer: First Health Workers Compensation |
$209.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$488.70
|
| Rate for Payer: GEHA Commercial |
$434.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$488.70
|
| Rate for Payer: Humana ChoiceCare |
$141.18
|
| Rate for Payer: Multiplan All |
$494.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$325.80
|
| Rate for Payer: OMNI Networks Commercial |
$380.10
|
| Rate for Payer: One Health Plan PPO/POS |
$488.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$515.85
|
| Rate for Payer: Three Rivers Provider Network All |
$407.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$477.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$504.99
|
| Rate for Payer: Zelis Auto |
$217.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$271.50
|
| Rate for Payer: Zelis Worker's Compensation |
$148.24
|
|
|
HOME/RES VISIT EST PATNT HIGH MDM 60 MIN
|
Facility
|
IP
|
$543.00
|
|
|
Service Code
|
CPT 99350
|
| Hospital Charge Code |
8599350
|
|
Hospital Revenue Code
|
522
|
| Min. Negotiated Rate |
$148.24 |
| Max. Negotiated Rate |
$515.85 |
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cigna Commercial |
$461.55
|
| Rate for Payer: First Health Commercial |
$488.70
|
| Rate for Payer: First Health Workers Compensation |
$209.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$488.70
|
| Rate for Payer: GEHA Commercial |
$380.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$488.70
|
| Rate for Payer: Multiplan All |
$494.13
|
| Rate for Payer: OMNI Networks Commercial |
$380.10
|
| Rate for Payer: One Health Plan PPO/POS |
$488.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$515.85
|
| Rate for Payer: Three Rivers Provider Network All |
$407.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$504.99
|
| Rate for Payer: Zelis Auto |
$217.20
|
| Rate for Payer: Zelis Worker's Compensation |
$148.24
|
|
|
HOME/RES VISIT EST PATNT HIGH MDM 60 MIN
|
Facility
|
IP
|
$543.00
|
|
|
Service Code
|
CPT 99350
|
| Hospital Charge Code |
9699350
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$148.24 |
| Max. Negotiated Rate |
$515.85 |
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cigna Commercial |
$461.55
|
| Rate for Payer: First Health Commercial |
$488.70
|
| Rate for Payer: First Health Workers Compensation |
$209.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$488.70
|
| Rate for Payer: GEHA Commercial |
$380.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$488.70
|
| Rate for Payer: Multiplan All |
$494.13
|
| Rate for Payer: OMNI Networks Commercial |
$380.10
|
| Rate for Payer: One Health Plan PPO/POS |
$488.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$515.85
|
| Rate for Payer: Three Rivers Provider Network All |
$407.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$504.99
|
| Rate for Payer: Zelis Auto |
$217.20
|
| Rate for Payer: Zelis Worker's Compensation |
$148.24
|
|
|
HOME/RES VISIT EST PATNT LOW MDM 30 MIN
|
Facility
|
IP
|
$259.00
|
|
|
Service Code
|
CPT 99348
|
| Hospital Charge Code |
8599348
|
|
Hospital Revenue Code
|
522
|
| Min. Negotiated Rate |
$70.71 |
| Max. Negotiated Rate |
$246.05 |
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$220.15
|
| Rate for Payer: First Health Commercial |
$233.10
|
| Rate for Payer: First Health Workers Compensation |
$100.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$233.10
|
| Rate for Payer: GEHA Commercial |
$181.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$233.10
|
| Rate for Payer: Multiplan All |
$235.69
|
| Rate for Payer: OMNI Networks Commercial |
$181.30
|
| Rate for Payer: One Health Plan PPO/POS |
$233.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$246.05
|
| Rate for Payer: Three Rivers Provider Network All |
$194.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$240.87
|
| Rate for Payer: Zelis Auto |
$103.60
|
| Rate for Payer: Zelis Worker's Compensation |
$70.71
|
|
|
HOME/RES VISIT EST PATNT LOW MDM 30 MIN
|
Facility
|
IP
|
$259.00
|
|
|
Service Code
|
CPT 99348
|
| Hospital Charge Code |
8799348
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$70.71 |
| Max. Negotiated Rate |
$246.05 |
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$220.15
|
| Rate for Payer: First Health Commercial |
$233.10
|
| Rate for Payer: First Health Workers Compensation |
$100.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$233.10
|
| Rate for Payer: GEHA Commercial |
$181.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$233.10
|
| Rate for Payer: Multiplan All |
$235.69
|
| Rate for Payer: OMNI Networks Commercial |
$181.30
|
| Rate for Payer: One Health Plan PPO/POS |
$233.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$246.05
|
| Rate for Payer: Three Rivers Provider Network All |
$194.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$240.87
|
| Rate for Payer: Zelis Auto |
$103.60
|
| Rate for Payer: Zelis Worker's Compensation |
$70.71
|
|
|
HOME/RES VISIT EST PATNT LOW MDM 30 MIN
|
Facility
|
OP
|
$259.00
|
|
|
Service Code
|
CPT 99348
|
| Hospital Charge Code |
8599348
|
|
Hospital Revenue Code
|
522
|
| Min. Negotiated Rate |
$64.75 |
| Max. Negotiated Rate |
$246.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$155.40
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$220.15
|
| Rate for Payer: First Health Commercial |
$233.10
|
| Rate for Payer: First Health Workers Compensation |
$100.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$233.10
|
| Rate for Payer: GEHA Commercial |
$207.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$233.10
|
| Rate for Payer: Humana ChoiceCare |
$67.34
|
| Rate for Payer: Multiplan All |
$235.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$155.40
|
| Rate for Payer: OMNI Networks Commercial |
$181.30
|
| Rate for Payer: One Health Plan PPO/POS |
$233.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$246.05
|
| Rate for Payer: Three Rivers Provider Network All |
$194.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$227.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$64.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$240.87
|
| Rate for Payer: Zelis Auto |
$103.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$129.50
|
| Rate for Payer: Zelis Worker's Compensation |
$70.71
|
|
|
HOME/RES VISIT EST PATNT LOW MDM 30 MIN
|
Facility
|
IP
|
$259.00
|
|
|
Service Code
|
CPT 99348
|
| Hospital Charge Code |
9699348
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$70.71 |
| Max. Negotiated Rate |
$246.05 |
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$220.15
|
| Rate for Payer: First Health Commercial |
$233.10
|
| Rate for Payer: First Health Workers Compensation |
$100.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$233.10
|
| Rate for Payer: GEHA Commercial |
$181.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$233.10
|
| Rate for Payer: Multiplan All |
$235.69
|
| Rate for Payer: OMNI Networks Commercial |
$181.30
|
| Rate for Payer: One Health Plan PPO/POS |
$233.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$246.05
|
| Rate for Payer: Three Rivers Provider Network All |
$194.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$240.87
|
| Rate for Payer: Zelis Auto |
$103.60
|
| Rate for Payer: Zelis Worker's Compensation |
$70.71
|
|
|
HOME/RES VISIT EST PATNT LOW MDM 30 MIN
|
Facility
|
OP
|
$259.00
|
|
|
Service Code
|
CPT 99348
|
| Hospital Charge Code |
9699348
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.75 |
| Max. Negotiated Rate |
$246.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$155.40
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$220.15
|
| Rate for Payer: First Health Commercial |
$233.10
|
| Rate for Payer: First Health Workers Compensation |
$100.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$233.10
|
| Rate for Payer: GEHA Commercial |
$207.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$233.10
|
| Rate for Payer: Humana ChoiceCare |
$67.34
|
| Rate for Payer: Multiplan All |
$235.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$155.40
|
| Rate for Payer: OMNI Networks Commercial |
$181.30
|
| Rate for Payer: One Health Plan PPO/POS |
$233.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$246.05
|
| Rate for Payer: Three Rivers Provider Network All |
$194.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$227.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$64.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$240.87
|
| Rate for Payer: Zelis Auto |
$103.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$129.50
|
| Rate for Payer: Zelis Worker's Compensation |
$70.71
|
|
|
HOME/RES VISIT EST PATNT LOW MDM 30 MIN
|
Facility
|
OP
|
$259.00
|
|
|
Service Code
|
CPT 99348
|
| Hospital Charge Code |
8799348
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.75 |
| Max. Negotiated Rate |
$246.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$155.40
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$220.15
|
| Rate for Payer: First Health Commercial |
$233.10
|
| Rate for Payer: First Health Workers Compensation |
$100.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$233.10
|
| Rate for Payer: GEHA Commercial |
$207.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$233.10
|
| Rate for Payer: Humana ChoiceCare |
$67.34
|
| Rate for Payer: Multiplan All |
$235.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$155.40
|
| Rate for Payer: OMNI Networks Commercial |
$181.30
|
| Rate for Payer: One Health Plan PPO/POS |
$233.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$246.05
|
| Rate for Payer: Three Rivers Provider Network All |
$194.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$227.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$64.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$240.87
|
| Rate for Payer: Zelis Auto |
$103.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$129.50
|
| Rate for Payer: Zelis Worker's Compensation |
$70.71
|
|
|
HOME/RES VISIT EST PATNT MOD MDM 40 MIN
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
CPT 99349
|
| Hospital Charge Code |
9699349
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$106.74 |
| Max. Negotiated Rate |
$371.45 |
| Rate for Payer: Cash Price |
$234.60
|
| Rate for Payer: Cigna Commercial |
$332.35
|
| Rate for Payer: First Health Commercial |
$351.90
|
| Rate for Payer: First Health Workers Compensation |
$150.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$351.90
|
| Rate for Payer: GEHA Commercial |
$273.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$351.90
|
| Rate for Payer: Multiplan All |
$355.81
|
| Rate for Payer: OMNI Networks Commercial |
$273.70
|
| Rate for Payer: One Health Plan PPO/POS |
$351.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$371.45
|
| Rate for Payer: Three Rivers Provider Network All |
$293.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$363.63
|
| Rate for Payer: Zelis Auto |
$156.40
|
| Rate for Payer: Zelis Worker's Compensation |
$106.74
|
|
|
HOME/RES VISIT EST PATNT MOD MDM 40 MIN
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
CPT 99349
|
| Hospital Charge Code |
8799349
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$106.74 |
| Max. Negotiated Rate |
$371.45 |
| Rate for Payer: Cash Price |
$234.60
|
| Rate for Payer: Cigna Commercial |
$332.35
|
| Rate for Payer: First Health Commercial |
$351.90
|
| Rate for Payer: First Health Workers Compensation |
$150.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$351.90
|
| Rate for Payer: GEHA Commercial |
$273.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$351.90
|
| Rate for Payer: Multiplan All |
$355.81
|
| Rate for Payer: OMNI Networks Commercial |
$273.70
|
| Rate for Payer: One Health Plan PPO/POS |
$351.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$371.45
|
| Rate for Payer: Three Rivers Provider Network All |
$293.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$363.63
|
| Rate for Payer: Zelis Auto |
$156.40
|
| Rate for Payer: Zelis Worker's Compensation |
$106.74
|
|
|
HOME/RES VISIT EST PATNT MOD MDM 40 MIN
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
CPT 99349
|
| Hospital Charge Code |
8599349
|
|
Hospital Revenue Code
|
522
|
| Min. Negotiated Rate |
$97.75 |
| Max. Negotiated Rate |
$371.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$234.60
|
| Rate for Payer: Cash Price |
$234.60
|
| Rate for Payer: Cigna Commercial |
$332.35
|
| Rate for Payer: First Health Commercial |
$351.90
|
| Rate for Payer: First Health Workers Compensation |
$150.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$351.90
|
| Rate for Payer: GEHA Commercial |
$312.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$351.90
|
| Rate for Payer: Humana ChoiceCare |
$101.66
|
| Rate for Payer: Multiplan All |
$355.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$234.60
|
| Rate for Payer: OMNI Networks Commercial |
$273.70
|
| Rate for Payer: One Health Plan PPO/POS |
$351.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$371.45
|
| Rate for Payer: Three Rivers Provider Network All |
$293.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$344.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$97.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$363.63
|
| Rate for Payer: Zelis Auto |
$156.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$195.50
|
| Rate for Payer: Zelis Worker's Compensation |
$106.74
|
|
|
HOME/RES VISIT EST PATNT MOD MDM 40 MIN
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
CPT 99349
|
| Hospital Charge Code |
8799349
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$97.75 |
| Max. Negotiated Rate |
$371.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$234.60
|
| Rate for Payer: Cash Price |
$234.60
|
| Rate for Payer: Cigna Commercial |
$332.35
|
| Rate for Payer: First Health Commercial |
$351.90
|
| Rate for Payer: First Health Workers Compensation |
$150.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$351.90
|
| Rate for Payer: GEHA Commercial |
$312.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$351.90
|
| Rate for Payer: Humana ChoiceCare |
$101.66
|
| Rate for Payer: Multiplan All |
$355.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$234.60
|
| Rate for Payer: OMNI Networks Commercial |
$273.70
|
| Rate for Payer: One Health Plan PPO/POS |
$351.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$371.45
|
| Rate for Payer: Three Rivers Provider Network All |
$293.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$344.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$97.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$363.63
|
| Rate for Payer: Zelis Auto |
$156.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$195.50
|
| Rate for Payer: Zelis Worker's Compensation |
$106.74
|
|
