|
INITIAL NRSNG FAC CARE SF/LOW MDM 25 MIN
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT 99304
|
| Hospital Charge Code |
1900046
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$66.00 |
| Max. Negotiated Rate |
$250.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cigna Commercial |
$224.40
|
| Rate for Payer: First Health Commercial |
$237.60
|
| Rate for Payer: First Health Workers Compensation |
$101.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$237.60
|
| Rate for Payer: GEHA Commercial |
$211.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$237.60
|
| Rate for Payer: Humana ChoiceCare |
$68.64
|
| Rate for Payer: Multiplan All |
$240.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$158.40
|
| Rate for Payer: OMNI Networks Commercial |
$184.80
|
| Rate for Payer: One Health Plan PPO/POS |
$237.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$250.80
|
| Rate for Payer: Three Rivers Provider Network All |
$198.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$232.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$66.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$245.52
|
| Rate for Payer: Zelis Auto |
$105.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$132.00
|
| Rate for Payer: Zelis Worker's Compensation |
$72.07
|
|
|
INITIAL NRSNG FAC CARE SF/LOW MDM 25 MIN
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
CPT 99304
|
| Hospital Charge Code |
9400064
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$68.75 |
| Max. Negotiated Rate |
$261.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$233.75
|
| Rate for Payer: First Health Commercial |
$247.50
|
| Rate for Payer: First Health Workers Compensation |
$106.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$247.50
|
| Rate for Payer: GEHA Commercial |
$220.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$247.50
|
| Rate for Payer: Humana ChoiceCare |
$71.50
|
| Rate for Payer: Multiplan All |
$250.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$165.00
|
| Rate for Payer: OMNI Networks Commercial |
$192.50
|
| Rate for Payer: One Health Plan PPO/POS |
$247.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$261.25
|
| Rate for Payer: Three Rivers Provider Network All |
$206.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$242.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$68.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$255.75
|
| Rate for Payer: Zelis Auto |
$110.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$137.50
|
| Rate for Payer: Zelis Worker's Compensation |
$75.08
|
|
|
INITIAL NRSNG FAC CARE SF/LOW MDM 25 MIN
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
CPT 99304
|
| Hospital Charge Code |
9400064
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$75.08 |
| Max. Negotiated Rate |
$261.25 |
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$233.75
|
| Rate for Payer: First Health Commercial |
$247.50
|
| Rate for Payer: First Health Workers Compensation |
$106.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$247.50
|
| Rate for Payer: GEHA Commercial |
$192.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$247.50
|
| Rate for Payer: Multiplan All |
$250.25
|
| Rate for Payer: OMNI Networks Commercial |
$192.50
|
| Rate for Payer: One Health Plan PPO/POS |
$247.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$261.25
|
| Rate for Payer: Three Rivers Provider Network All |
$206.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$255.75
|
| Rate for Payer: Zelis Auto |
$110.00
|
| Rate for Payer: Zelis Worker's Compensation |
$75.08
|
|
|
INITIAL NURSING FAC CARE MOD MDM 35 MINS
|
Facility
|
OP
|
$397.00
|
|
|
Service Code
|
CPT 99305
|
| Hospital Charge Code |
8599305
|
|
Hospital Revenue Code
|
524
|
| Min. Negotiated Rate |
$99.25 |
| Max. Negotiated Rate |
$377.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$238.20
|
| Rate for Payer: Cash Price |
$238.20
|
| Rate for Payer: Cigna Commercial |
$337.45
|
| Rate for Payer: First Health Commercial |
$357.30
|
| Rate for Payer: First Health Workers Compensation |
$153.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$357.30
|
| Rate for Payer: GEHA Commercial |
$317.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$357.30
|
| Rate for Payer: Humana ChoiceCare |
$103.22
|
| Rate for Payer: Multiplan All |
$361.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$238.20
|
| Rate for Payer: OMNI Networks Commercial |
$277.90
|
| Rate for Payer: One Health Plan PPO/POS |
$357.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$377.15
|
| Rate for Payer: Three Rivers Provider Network All |
$297.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$349.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$99.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$369.21
|
| Rate for Payer: Zelis Auto |
$158.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$198.50
|
| Rate for Payer: Zelis Worker's Compensation |
$108.38
|
|
|
INITIAL NURSING FAC CARE MOD MDM 35 MINS
|
Facility
|
IP
|
$397.00
|
|
|
Service Code
|
CPT 99305
|
| Hospital Charge Code |
8599305
|
|
Hospital Revenue Code
|
524
|
| Min. Negotiated Rate |
$108.38 |
| Max. Negotiated Rate |
$377.15 |
| Rate for Payer: Cash Price |
$238.20
|
| Rate for Payer: Cigna Commercial |
$337.45
|
| Rate for Payer: First Health Commercial |
$357.30
|
| Rate for Payer: First Health Workers Compensation |
$153.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$357.30
|
| Rate for Payer: GEHA Commercial |
$277.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$357.30
|
| Rate for Payer: Multiplan All |
$361.27
|
| Rate for Payer: OMNI Networks Commercial |
$277.90
|
| Rate for Payer: One Health Plan PPO/POS |
$357.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$377.15
|
| Rate for Payer: Three Rivers Provider Network All |
$297.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$369.21
|
| Rate for Payer: Zelis Auto |
$158.80
|
| Rate for Payer: Zelis Worker's Compensation |
$108.38
|
|
|
INITIAL NURSING FAC CARE MOD MDM 35 MINS
|
Facility
|
IP
|
$397.00
|
|
|
Service Code
|
CPT 99305
|
| Hospital Charge Code |
9400065
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$108.38 |
| Max. Negotiated Rate |
$377.15 |
| Rate for Payer: Cash Price |
$238.20
|
| Rate for Payer: Cigna Commercial |
$337.45
|
| Rate for Payer: First Health Commercial |
$357.30
|
| Rate for Payer: First Health Workers Compensation |
$153.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$357.30
|
| Rate for Payer: GEHA Commercial |
$277.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$357.30
|
| Rate for Payer: Multiplan All |
$361.27
|
| Rate for Payer: OMNI Networks Commercial |
$277.90
|
| Rate for Payer: One Health Plan PPO/POS |
$357.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$377.15
|
| Rate for Payer: Three Rivers Provider Network All |
$297.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$369.21
|
| Rate for Payer: Zelis Auto |
$158.80
|
| Rate for Payer: Zelis Worker's Compensation |
$108.38
|
|
|
INITIAL NURSING FAC CARE MOD MDM 35 MINS
|
Facility
|
OP
|
$397.00
|
|
|
Service Code
|
CPT 99305
|
| Hospital Charge Code |
9400065
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$99.25 |
| Max. Negotiated Rate |
$377.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$238.20
|
| Rate for Payer: Cash Price |
$238.20
|
| Rate for Payer: Cigna Commercial |
$337.45
|
| Rate for Payer: First Health Commercial |
$357.30
|
| Rate for Payer: First Health Workers Compensation |
$153.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$357.30
|
| Rate for Payer: GEHA Commercial |
$317.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$357.30
|
| Rate for Payer: Humana ChoiceCare |
$103.22
|
| Rate for Payer: Multiplan All |
$361.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$238.20
|
| Rate for Payer: OMNI Networks Commercial |
$277.90
|
| Rate for Payer: One Health Plan PPO/POS |
$357.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$377.15
|
| Rate for Payer: Three Rivers Provider Network All |
$297.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$349.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$99.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$369.21
|
| Rate for Payer: Zelis Auto |
$158.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$198.50
|
| Rate for Payer: Zelis Worker's Compensation |
$108.38
|
|
|
INITIAL NURSING FAC CARE MOD MDM 45 MINS
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
CPT 99306
|
| Hospital Charge Code |
8599306
|
|
Hospital Revenue Code
|
524
|
| Min. Negotiated Rate |
$138.96 |
| Max. Negotiated Rate |
$483.55 |
| Rate for Payer: Cash Price |
$305.40
|
| Rate for Payer: Cigna Commercial |
$432.65
|
| Rate for Payer: First Health Commercial |
$458.10
|
| Rate for Payer: First Health Workers Compensation |
$196.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$458.10
|
| Rate for Payer: GEHA Commercial |
$356.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$458.10
|
| Rate for Payer: Multiplan All |
$463.19
|
| Rate for Payer: OMNI Networks Commercial |
$356.30
|
| Rate for Payer: One Health Plan PPO/POS |
$458.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$483.55
|
| Rate for Payer: Three Rivers Provider Network All |
$381.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$473.37
|
| Rate for Payer: Zelis Auto |
$203.60
|
| Rate for Payer: Zelis Worker's Compensation |
$138.96
|
|
|
INITIAL NURSING FAC CARE MOD MDM 45 MINS
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
CPT 99306
|
| Hospital Charge Code |
9400066
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$138.96 |
| Max. Negotiated Rate |
$483.55 |
| Rate for Payer: Cash Price |
$305.40
|
| Rate for Payer: Cigna Commercial |
$432.65
|
| Rate for Payer: First Health Commercial |
$458.10
|
| Rate for Payer: First Health Workers Compensation |
$196.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$458.10
|
| Rate for Payer: GEHA Commercial |
$356.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$458.10
|
| Rate for Payer: Multiplan All |
$463.19
|
| Rate for Payer: OMNI Networks Commercial |
$356.30
|
| Rate for Payer: One Health Plan PPO/POS |
$458.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$483.55
|
| Rate for Payer: Three Rivers Provider Network All |
$381.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$473.37
|
| Rate for Payer: Zelis Auto |
$203.60
|
| Rate for Payer: Zelis Worker's Compensation |
$138.96
|
|
|
INITIAL NURSING FAC CARE MOD MDM 45 MINS
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
CPT 99306
|
| Hospital Charge Code |
8599306
|
|
Hospital Revenue Code
|
524
|
| Min. Negotiated Rate |
$127.25 |
| Max. Negotiated Rate |
$483.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$305.40
|
| Rate for Payer: Cash Price |
$305.40
|
| Rate for Payer: Cigna Commercial |
$432.65
|
| Rate for Payer: First Health Commercial |
$458.10
|
| Rate for Payer: First Health Workers Compensation |
$196.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$458.10
|
| Rate for Payer: GEHA Commercial |
$407.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$458.10
|
| Rate for Payer: Humana ChoiceCare |
$132.34
|
| Rate for Payer: Multiplan All |
$463.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$305.40
|
| Rate for Payer: OMNI Networks Commercial |
$356.30
|
| Rate for Payer: One Health Plan PPO/POS |
$458.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$483.55
|
| Rate for Payer: Three Rivers Provider Network All |
$381.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$447.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$127.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$473.37
|
| Rate for Payer: Zelis Auto |
$203.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$254.50
|
| Rate for Payer: Zelis Worker's Compensation |
$138.96
|
|
|
INITIAL NURSING FAC CARE MOD MDM 45 MINS
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
CPT 99306
|
| Hospital Charge Code |
9400066
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$127.25 |
| Max. Negotiated Rate |
$483.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$305.40
|
| Rate for Payer: Cash Price |
$305.40
|
| Rate for Payer: Cigna Commercial |
$432.65
|
| Rate for Payer: First Health Commercial |
$458.10
|
| Rate for Payer: First Health Workers Compensation |
$196.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$458.10
|
| Rate for Payer: GEHA Commercial |
$407.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$458.10
|
| Rate for Payer: Humana ChoiceCare |
$132.34
|
| Rate for Payer: Multiplan All |
$463.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$305.40
|
| Rate for Payer: OMNI Networks Commercial |
$356.30
|
| Rate for Payer: One Health Plan PPO/POS |
$458.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$483.55
|
| Rate for Payer: Three Rivers Provider Network All |
$381.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$447.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$127.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$473.37
|
| Rate for Payer: Zelis Auto |
$203.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$254.50
|
| Rate for Payer: Zelis Worker's Compensation |
$138.96
|
|
|
INITIAL OBSERVATION CARE/DAY 30 MINUTES
|
Facility
|
OP
|
$289.00
|
|
|
Service Code
|
CPT 99218
|
| Hospital Charge Code |
8299218
|
|
Hospital Revenue Code
|
960
|
| 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
|
|
|
INITIAL OBSERVATION CARE/DAY 30 MINUTES
|
Facility
|
IP
|
$289.00
|
|
|
Service Code
|
CPT 99218
|
| Hospital Charge Code |
21799472
|
|
Hospital Revenue Code
|
960
|
| 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
|
|
|
INITIAL OBSERVATION CARE/DAY 30 MINUTES
|
Facility
|
OP
|
$289.00
|
|
|
Service Code
|
CPT 99218
|
| Hospital Charge Code |
21999403
|
|
Hospital Revenue Code
|
960
|
| 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
|
|
|
INITIAL OBSERVATION CARE/DAY 30 MINUTES
|
Facility
|
IP
|
$289.00
|
|
|
Service Code
|
CPT 99218
|
| Hospital Charge Code |
21999403
|
|
Hospital Revenue Code
|
960
|
| 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
|
|
|
INITIAL OBSERVATION CARE/DAY 30 MINUTES
|
Facility
|
OP
|
$289.00
|
|
|
Service Code
|
CPT 99218
|
| Hospital Charge Code |
21799472
|
|
Hospital Revenue Code
|
960
|
| 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
|
|
|
INITIAL OBSERVATION CARE/DAY 30 MINUTES
|
Facility
|
IP
|
$289.00
|
|
|
Service Code
|
CPT 99218
|
| Hospital Charge Code |
8299218
|
|
Hospital Revenue Code
|
960
|
| 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
|
|
|
INITIAL OBSERVATION CARE/DAY 50 MINUTES
|
Facility
|
IP
|
$416.00
|
|
|
Service Code
|
CPT 99219
|
| Hospital Charge Code |
8299219
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$113.57 |
| Max. Negotiated Rate |
$395.20 |
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cigna Commercial |
$353.60
|
| Rate for Payer: First Health Commercial |
$374.40
|
| Rate for Payer: First Health Workers Compensation |
$160.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$374.40
|
| Rate for Payer: GEHA Commercial |
$291.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$374.40
|
| Rate for Payer: Multiplan All |
$378.56
|
| Rate for Payer: OMNI Networks Commercial |
$291.20
|
| Rate for Payer: One Health Plan PPO/POS |
$374.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$395.20
|
| Rate for Payer: Three Rivers Provider Network All |
$312.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$386.88
|
| Rate for Payer: Zelis Auto |
$166.40
|
| Rate for Payer: Zelis Worker's Compensation |
$113.57
|
|
|
INITIAL OBSERVATION CARE/DAY 50 MINUTES
|
Facility
|
OP
|
$416.00
|
|
|
Service Code
|
CPT 99219
|
| Hospital Charge Code |
8299219
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$395.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$249.60
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cigna Commercial |
$353.60
|
| Rate for Payer: First Health Commercial |
$374.40
|
| Rate for Payer: First Health Workers Compensation |
$160.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$374.40
|
| Rate for Payer: GEHA Commercial |
$332.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$374.40
|
| Rate for Payer: Humana ChoiceCare |
$108.16
|
| Rate for Payer: Multiplan All |
$378.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$249.60
|
| Rate for Payer: OMNI Networks Commercial |
$291.20
|
| Rate for Payer: One Health Plan PPO/POS |
$374.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$395.20
|
| Rate for Payer: Three Rivers Provider Network All |
$312.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$366.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$104.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$386.88
|
| Rate for Payer: Zelis Auto |
$166.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$208.00
|
| Rate for Payer: Zelis Worker's Compensation |
$113.57
|
|
|
INITIAL OBSERVATION CARE/DAY 50 MINUTES
|
Facility
|
IP
|
$416.00
|
|
|
Service Code
|
CPT 99219
|
| Hospital Charge Code |
21999404
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$113.57 |
| Max. Negotiated Rate |
$395.20 |
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cigna Commercial |
$353.60
|
| Rate for Payer: First Health Commercial |
$374.40
|
| Rate for Payer: First Health Workers Compensation |
$160.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$374.40
|
| Rate for Payer: GEHA Commercial |
$291.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$374.40
|
| Rate for Payer: Multiplan All |
$378.56
|
| Rate for Payer: OMNI Networks Commercial |
$291.20
|
| Rate for Payer: One Health Plan PPO/POS |
$374.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$395.20
|
| Rate for Payer: Three Rivers Provider Network All |
$312.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$386.88
|
| Rate for Payer: Zelis Auto |
$166.40
|
| Rate for Payer: Zelis Worker's Compensation |
$113.57
|
|
|
INITIAL OBSERVATION CARE/DAY 50 MINUTES
|
Facility
|
OP
|
$416.00
|
|
|
Service Code
|
CPT 99219
|
| Hospital Charge Code |
21999404
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$395.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$249.60
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cigna Commercial |
$353.60
|
| Rate for Payer: First Health Commercial |
$374.40
|
| Rate for Payer: First Health Workers Compensation |
$160.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$374.40
|
| Rate for Payer: GEHA Commercial |
$332.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$374.40
|
| Rate for Payer: Humana ChoiceCare |
$108.16
|
| Rate for Payer: Multiplan All |
$378.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$249.60
|
| Rate for Payer: OMNI Networks Commercial |
$291.20
|
| Rate for Payer: One Health Plan PPO/POS |
$374.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$395.20
|
| Rate for Payer: Three Rivers Provider Network All |
$312.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$366.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$104.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$386.88
|
| Rate for Payer: Zelis Auto |
$166.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$208.00
|
| Rate for Payer: Zelis Worker's Compensation |
$113.57
|
|
|
INITIAL OBSERVATION CARE/DAY 50 MINUTES
|
Facility
|
OP
|
$416.00
|
|
|
Service Code
|
CPT 99219
|
| Hospital Charge Code |
21799473
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$395.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$249.60
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cigna Commercial |
$353.60
|
| Rate for Payer: First Health Commercial |
$374.40
|
| Rate for Payer: First Health Workers Compensation |
$160.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$374.40
|
| Rate for Payer: GEHA Commercial |
$332.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$374.40
|
| Rate for Payer: Humana ChoiceCare |
$108.16
|
| Rate for Payer: Multiplan All |
$378.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$249.60
|
| Rate for Payer: OMNI Networks Commercial |
$291.20
|
| Rate for Payer: One Health Plan PPO/POS |
$374.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$395.20
|
| Rate for Payer: Three Rivers Provider Network All |
$312.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$366.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$104.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$386.88
|
| Rate for Payer: Zelis Auto |
$166.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$208.00
|
| Rate for Payer: Zelis Worker's Compensation |
$113.57
|
|
|
INITIAL OBSERVATION CARE/DAY 50 MINUTES
|
Facility
|
IP
|
$416.00
|
|
|
Service Code
|
CPT 99219
|
| Hospital Charge Code |
21799473
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$113.57 |
| Max. Negotiated Rate |
$395.20 |
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cigna Commercial |
$353.60
|
| Rate for Payer: First Health Commercial |
$374.40
|
| Rate for Payer: First Health Workers Compensation |
$160.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$374.40
|
| Rate for Payer: GEHA Commercial |
$291.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$374.40
|
| Rate for Payer: Multiplan All |
$378.56
|
| Rate for Payer: OMNI Networks Commercial |
$291.20
|
| Rate for Payer: One Health Plan PPO/POS |
$374.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$395.20
|
| Rate for Payer: Three Rivers Provider Network All |
$312.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$386.88
|
| Rate for Payer: Zelis Auto |
$166.40
|
| Rate for Payer: Zelis Worker's Compensation |
$113.57
|
|
|
INITIAL OBSERVATION CARE/DAY 70 MINUTES
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
CPT 99220
|
| Hospital Charge Code |
8299220
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$133.75 |
| Max. Negotiated Rate |
$508.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$321.00
|
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: Cigna Commercial |
$454.75
|
| Rate for Payer: First Health Commercial |
$481.50
|
| Rate for Payer: First Health Workers Compensation |
$206.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$481.50
|
| Rate for Payer: GEHA Commercial |
$428.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$481.50
|
| Rate for Payer: Humana ChoiceCare |
$139.10
|
| Rate for Payer: Multiplan All |
$486.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$321.00
|
| Rate for Payer: OMNI Networks Commercial |
$374.50
|
| Rate for Payer: One Health Plan PPO/POS |
$481.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$508.25
|
| Rate for Payer: Three Rivers Provider Network All |
$401.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$470.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$133.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$497.55
|
| Rate for Payer: Zelis Auto |
$214.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$267.50
|
| Rate for Payer: Zelis Worker's Compensation |
$146.06
|
|
|
INITIAL OBSERVATION CARE/DAY 70 MINUTES
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
CPT 99220
|
| Hospital Charge Code |
21999405
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$133.75 |
| Max. Negotiated Rate |
$508.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$321.00
|
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: Cigna Commercial |
$454.75
|
| Rate for Payer: First Health Commercial |
$481.50
|
| Rate for Payer: First Health Workers Compensation |
$206.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$481.50
|
| Rate for Payer: GEHA Commercial |
$428.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$481.50
|
| Rate for Payer: Humana ChoiceCare |
$139.10
|
| Rate for Payer: Multiplan All |
$486.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$321.00
|
| Rate for Payer: OMNI Networks Commercial |
$374.50
|
| Rate for Payer: One Health Plan PPO/POS |
$481.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$508.25
|
| Rate for Payer: Three Rivers Provider Network All |
$401.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$470.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$133.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$497.55
|
| Rate for Payer: Zelis Auto |
$214.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$267.50
|
| Rate for Payer: Zelis Worker's Compensation |
$146.06
|
|
