|
NON-INVAS PHYSIOLOGIC STD EXTREMITY ART
|
Facility
|
OP
|
$897.00
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
1900041
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$78.88 |
| Max. Negotiated Rate |
$852.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$99.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$538.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$99.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$78.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$124.90
|
| Rate for Payer: Cash Price |
$538.20
|
| Rate for Payer: Cash Price |
$538.20
|
| Rate for Payer: Cigna Commercial |
$762.45
|
| Rate for Payer: First Health Commercial |
$807.30
|
| Rate for Payer: First Health Workers Compensation |
$346.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$807.30
|
| Rate for Payer: GEHA Commercial |
$717.60
|
| Rate for Payer: GEHA Medicare |
$124.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$807.30
|
| Rate for Payer: Humana ChoiceCare |
$137.39
|
| Rate for Payer: Humana Medicare Advantage |
$124.90
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$209.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$80.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$124.90
|
| Rate for Payer: Multiplan All |
$816.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$212.33
|
| Rate for Payer: OMNI Networks Commercial |
$627.90
|
| Rate for Payer: One Health Plan PPO/POS |
$807.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$92.93
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$80.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$124.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$852.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$249.80
|
| Rate for Payer: Three Rivers Provider Network All |
$672.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$122.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$80.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$124.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$834.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$124.90
|
| Rate for Payer: Zelis Auto |
$358.80
|
| Rate for Payer: Zelis Medicare |
$106.17
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$149.88
|
| Rate for Payer: Zelis Worker's Compensation |
$244.88
|
|
|
NON-INVAS PHYSIOLOGIC STD EXTREMITY ART
|
Facility
|
IP
|
$897.00
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
1900041
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$244.88 |
| Max. Negotiated Rate |
$852.15 |
| Rate for Payer: Cash Price |
$538.20
|
| Rate for Payer: Cigna Commercial |
$762.45
|
| Rate for Payer: First Health Commercial |
$807.30
|
| Rate for Payer: First Health Workers Compensation |
$346.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$807.30
|
| Rate for Payer: GEHA Commercial |
$627.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$807.30
|
| Rate for Payer: Multiplan All |
$816.27
|
| Rate for Payer: OMNI Networks Commercial |
$627.90
|
| Rate for Payer: One Health Plan PPO/POS |
$807.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$852.15
|
| Rate for Payer: Three Rivers Provider Network All |
$672.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$834.21
|
| Rate for Payer: Zelis Auto |
$358.80
|
| Rate for Payer: Zelis Worker's Compensation |
$244.88
|
|
|
NON-INVAS PHYSIOLOGIC STD EXTREMITY ART
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
20300041
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$68.52 |
| Max. Negotiated Rate |
$249.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$99.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$150.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$99.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$78.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$124.90
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cigna Commercial |
$213.35
|
| Rate for Payer: First Health Commercial |
$225.90
|
| Rate for Payer: First Health Workers Compensation |
$96.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$225.90
|
| Rate for Payer: GEHA Commercial |
$200.80
|
| Rate for Payer: GEHA Medicare |
$124.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$225.90
|
| Rate for Payer: Humana ChoiceCare |
$137.39
|
| Rate for Payer: Humana Medicare Advantage |
$124.90
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$209.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$80.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$124.90
|
| Rate for Payer: Multiplan All |
$228.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$212.33
|
| Rate for Payer: OMNI Networks Commercial |
$175.70
|
| Rate for Payer: One Health Plan PPO/POS |
$225.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$92.93
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$80.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$124.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$238.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$249.80
|
| Rate for Payer: Three Rivers Provider Network All |
$188.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$122.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$80.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$124.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$233.43
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$124.90
|
| Rate for Payer: Zelis Auto |
$100.40
|
| Rate for Payer: Zelis Medicare |
$106.17
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$149.88
|
| Rate for Payer: Zelis Worker's Compensation |
$68.52
|
|
|
NON-INVAS PHYSIOLOGIC STD EXTREMITY ART
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
20300041
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$68.52 |
| Max. Negotiated Rate |
$238.45 |
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cigna Commercial |
$213.35
|
| Rate for Payer: First Health Commercial |
$225.90
|
| Rate for Payer: First Health Workers Compensation |
$96.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$225.90
|
| Rate for Payer: GEHA Commercial |
$175.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$225.90
|
| Rate for Payer: Multiplan All |
$228.41
|
| Rate for Payer: OMNI Networks Commercial |
$175.70
|
| Rate for Payer: One Health Plan PPO/POS |
$225.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$238.45
|
| Rate for Payer: Three Rivers Provider Network All |
$188.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$233.43
|
| Rate for Payer: Zelis Auto |
$100.40
|
| Rate for Payer: Zelis Worker's Compensation |
$68.52
|
|
|
NONINVASV PULSE OX CONT OVRNIGHT
|
Facility
|
OP
|
$572.00
|
|
|
Service Code
|
CPT 94762
|
| Hospital Charge Code |
4009010
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$77.05 |
| Max. Negotiated Rate |
$543.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$97.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$343.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$97.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$77.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$151.61
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cigna Commercial |
$486.20
|
| Rate for Payer: First Health Commercial |
$514.80
|
| Rate for Payer: First Health Workers Compensation |
$220.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$514.80
|
| Rate for Payer: GEHA Commercial |
$457.60
|
| Rate for Payer: GEHA Medicare |
$151.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$514.80
|
| Rate for Payer: Humana ChoiceCare |
$166.77
|
| Rate for Payer: Humana Medicare Advantage |
$151.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$254.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$78.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$151.61
|
| Rate for Payer: Multiplan All |
$520.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$257.74
|
| Rate for Payer: OMNI Networks Commercial |
$400.40
|
| Rate for Payer: One Health Plan PPO/POS |
$514.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$90.78
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$78.62
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$151.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$543.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$303.22
|
| Rate for Payer: Three Rivers Provider Network All |
$429.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$148.58
|
| Rate for Payer: United Healthcare Commercial |
$486.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$78.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$151.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$531.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$151.61
|
| Rate for Payer: Zelis Auto |
$228.80
|
| Rate for Payer: Zelis Medicare |
$128.87
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$181.93
|
| Rate for Payer: Zelis Worker's Compensation |
$156.16
|
|
|
NONINVASV PULSE OX CONT OVRNIGHT
|
Facility
|
IP
|
$572.00
|
|
|
Service Code
|
CPT 94762
|
| Hospital Charge Code |
4009010
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$156.16 |
| Max. Negotiated Rate |
$543.40 |
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cigna Commercial |
$486.20
|
| Rate for Payer: First Health Commercial |
$514.80
|
| Rate for Payer: First Health Workers Compensation |
$220.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$514.80
|
| Rate for Payer: GEHA Commercial |
$400.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$514.80
|
| Rate for Payer: Multiplan All |
$520.52
|
| Rate for Payer: OMNI Networks Commercial |
$400.40
|
| Rate for Payer: One Health Plan PPO/POS |
$514.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$543.40
|
| Rate for Payer: Three Rivers Provider Network All |
$429.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$531.96
|
| Rate for Payer: Zelis Auto |
$228.80
|
| Rate for Payer: Zelis Worker's Compensation |
$156.16
|
|
|
NONINVASV PULSE OX MULTI MEASRMNT
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 94761
|
| Hospital Charge Code |
4000625
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$49.41 |
| Max. Negotiated Rate |
$171.95 |
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cigna Commercial |
$153.85
|
| Rate for Payer: First Health Commercial |
$162.90
|
| Rate for Payer: First Health Workers Compensation |
$69.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$162.90
|
| Rate for Payer: GEHA Commercial |
$126.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$162.90
|
| Rate for Payer: Multiplan All |
$164.71
|
| Rate for Payer: OMNI Networks Commercial |
$126.70
|
| Rate for Payer: One Health Plan PPO/POS |
$162.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$171.95
|
| Rate for Payer: Three Rivers Provider Network All |
$135.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$168.33
|
| Rate for Payer: Zelis Auto |
$72.40
|
| Rate for Payer: Zelis Worker's Compensation |
$49.41
|
|
|
NONINVASV PULSE OX MULTI MEASRMNT
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 94761
|
| Hospital Charge Code |
4000625
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$45.25 |
| Max. Negotiated Rate |
$171.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$108.60
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cigna Commercial |
$153.85
|
| Rate for Payer: First Health Commercial |
$162.90
|
| Rate for Payer: First Health Workers Compensation |
$69.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$162.90
|
| Rate for Payer: GEHA Commercial |
$144.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$162.90
|
| Rate for Payer: Humana ChoiceCare |
$47.06
|
| Rate for Payer: Multiplan All |
$164.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$108.60
|
| Rate for Payer: OMNI Networks Commercial |
$126.70
|
| Rate for Payer: One Health Plan PPO/POS |
$162.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$171.95
|
| Rate for Payer: Three Rivers Provider Network All |
$135.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$159.28
|
| Rate for Payer: United Healthcare Commercial |
$153.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$45.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$168.33
|
| Rate for Payer: Zelis Auto |
$72.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$90.50
|
| Rate for Payer: Zelis Worker's Compensation |
$49.41
|
|
|
NONINVASV PULSE OX SINGLE MEASRMNT
|
Facility
|
OP
|
$151.59
|
|
|
Service Code
|
CPT 94760
|
| Hospital Charge Code |
4000011
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$37.90 |
| Max. Negotiated Rate |
$144.01 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$90.95
|
| Rate for Payer: Cash Price |
$90.95
|
| Rate for Payer: Cigna Commercial |
$128.85
|
| Rate for Payer: First Health Commercial |
$136.43
|
| Rate for Payer: First Health Workers Compensation |
$58.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$136.43
|
| Rate for Payer: GEHA Commercial |
$121.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$136.43
|
| Rate for Payer: Humana ChoiceCare |
$39.41
|
| Rate for Payer: Multiplan All |
$137.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$90.95
|
| Rate for Payer: OMNI Networks Commercial |
$106.11
|
| Rate for Payer: One Health Plan PPO/POS |
$136.43
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$144.01
|
| Rate for Payer: Three Rivers Provider Network All |
$113.69
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$133.40
|
| Rate for Payer: United Healthcare Commercial |
$128.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$37.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$140.98
|
| Rate for Payer: Zelis Auto |
$60.64
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$75.80
|
| Rate for Payer: Zelis Worker's Compensation |
$41.38
|
|
|
NONINVASV PULSE OX SINGLE MEASRMNT
|
Facility
|
IP
|
$151.59
|
|
|
Service Code
|
CPT 94760
|
| Hospital Charge Code |
4000011
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$41.38 |
| Max. Negotiated Rate |
$144.01 |
| Rate for Payer: Cash Price |
$90.95
|
| Rate for Payer: Cigna Commercial |
$128.85
|
| Rate for Payer: First Health Commercial |
$136.43
|
| Rate for Payer: First Health Workers Compensation |
$58.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$136.43
|
| Rate for Payer: GEHA Commercial |
$106.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$136.43
|
| Rate for Payer: Multiplan All |
$137.95
|
| Rate for Payer: OMNI Networks Commercial |
$106.11
|
| Rate for Payer: One Health Plan PPO/POS |
$136.43
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$144.01
|
| Rate for Payer: Three Rivers Provider Network All |
$113.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$140.98
|
| Rate for Payer: Zelis Auto |
$60.64
|
| Rate for Payer: Zelis Worker's Compensation |
$41.38
|
|
|
NONPHYSICIAN TELEPHONE ASSESSMENT 11-20
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT 98967
|
| Hospital Charge Code |
9698967
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$22.39 |
| Max. Negotiated Rate |
$77.90 |
| Rate for Payer: Zelis Worker's Compensation |
$22.39
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cigna Commercial |
$69.70
|
| Rate for Payer: First Health Commercial |
$73.80
|
| Rate for Payer: First Health Workers Compensation |
$31.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$73.80
|
| Rate for Payer: GEHA Commercial |
$57.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$73.80
|
| Rate for Payer: Multiplan All |
$74.62
|
| Rate for Payer: OMNI Networks Commercial |
$57.40
|
| Rate for Payer: One Health Plan PPO/POS |
$73.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$77.90
|
| Rate for Payer: Three Rivers Provider Network All |
$61.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$76.26
|
| Rate for Payer: Zelis Auto |
$32.80
|
|
|
NONPHYSICIAN TELEPHONE ASSESSMENT 11-20
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 98967
|
| Hospital Charge Code |
9098967
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$21.32 |
| Max. Negotiated Rate |
$77.90 |
| Rate for Payer: Cigna Commercial |
$69.70
|
| Rate for Payer: First Health Commercial |
$73.80
|
| Rate for Payer: First Health Workers Compensation |
$31.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$73.80
|
| Rate for Payer: GEHA Commercial |
$65.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$73.80
|
| Rate for Payer: Humana ChoiceCare |
$21.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$41.99
|
| Rate for Payer: Multiplan All |
$74.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$49.20
|
| Rate for Payer: OMNI Networks Commercial |
$57.40
|
| Rate for Payer: One Health Plan PPO/POS |
$73.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$48.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$41.99
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$77.90
|
| Rate for Payer: Three Rivers Provider Network All |
$61.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$72.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$41.99
|
| Rate for Payer: United Payors & United Providers UP&UP |
$76.26
|
| Rate for Payer: Zelis Auto |
$32.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$41.00
|
| Rate for Payer: Zelis Worker's Compensation |
$22.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$51.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$49.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$51.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$41.15
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cash Price |
$49.20
|
|
|
NONPHYSICIAN TELEPHONE ASSESSMENT 11-20
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 98967
|
| Hospital Charge Code |
8898967
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$21.32 |
| Max. Negotiated Rate |
$77.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$51.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$49.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$51.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$41.15
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cigna Commercial |
$69.70
|
| Rate for Payer: First Health Commercial |
$73.80
|
| Rate for Payer: First Health Workers Compensation |
$31.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$73.80
|
| Rate for Payer: GEHA Commercial |
$65.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$73.80
|
| Rate for Payer: Humana ChoiceCare |
$21.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$41.99
|
| Rate for Payer: Multiplan All |
$74.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$49.20
|
| Rate for Payer: OMNI Networks Commercial |
$57.40
|
| Rate for Payer: One Health Plan PPO/POS |
$73.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$48.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$41.99
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$77.90
|
| Rate for Payer: Three Rivers Provider Network All |
$61.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$72.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$41.99
|
| Rate for Payer: United Payors & United Providers UP&UP |
$76.26
|
| Rate for Payer: Zelis Auto |
$32.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$41.00
|
| Rate for Payer: Zelis Worker's Compensation |
$22.39
|
|
|
NONPHYSICIAN TELEPHONE ASSESSMENT 11-20
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT 98967
|
| Hospital Charge Code |
9798967
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$22.39 |
| Max. Negotiated Rate |
$77.90 |
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cigna Commercial |
$69.70
|
| Rate for Payer: First Health Commercial |
$73.80
|
| Rate for Payer: First Health Workers Compensation |
$31.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$73.80
|
| Rate for Payer: GEHA Commercial |
$57.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$73.80
|
| Rate for Payer: Multiplan All |
$74.62
|
| Rate for Payer: OMNI Networks Commercial |
$57.40
|
| Rate for Payer: One Health Plan PPO/POS |
$73.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$77.90
|
| Rate for Payer: Three Rivers Provider Network All |
$61.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$76.26
|
| Rate for Payer: Zelis Auto |
$32.80
|
| Rate for Payer: Zelis Worker's Compensation |
$22.39
|
|
|
NONPHYSICIAN TELEPHONE ASSESSMENT 11-20
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT 98967
|
| Hospital Charge Code |
9398967
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$22.39 |
| Max. Negotiated Rate |
$77.90 |
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cigna Commercial |
$69.70
|
| Rate for Payer: First Health Commercial |
$73.80
|
| Rate for Payer: First Health Workers Compensation |
$31.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$73.80
|
| Rate for Payer: GEHA Commercial |
$57.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$73.80
|
| Rate for Payer: Multiplan All |
$74.62
|
| Rate for Payer: OMNI Networks Commercial |
$57.40
|
| Rate for Payer: One Health Plan PPO/POS |
$73.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$77.90
|
| Rate for Payer: Three Rivers Provider Network All |
$61.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$76.26
|
| Rate for Payer: Zelis Auto |
$32.80
|
| Rate for Payer: Zelis Worker's Compensation |
$22.39
|
|
|
NONPHYSICIAN TELEPHONE ASSESSMENT 11-20
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 98967
|
| Hospital Charge Code |
8698967
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$21.32 |
| Max. Negotiated Rate |
$77.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$51.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$49.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$51.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$41.15
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cigna Commercial |
$69.70
|
| Rate for Payer: First Health Commercial |
$73.80
|
| Rate for Payer: First Health Workers Compensation |
$31.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$73.80
|
| Rate for Payer: GEHA Commercial |
$65.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$73.80
|
| Rate for Payer: Humana ChoiceCare |
$21.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$41.99
|
| Rate for Payer: Multiplan All |
$74.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$49.20
|
| Rate for Payer: OMNI Networks Commercial |
$57.40
|
| Rate for Payer: One Health Plan PPO/POS |
$73.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$48.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$41.99
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$77.90
|
| Rate for Payer: Three Rivers Provider Network All |
$61.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$72.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$41.99
|
| Rate for Payer: United Payors & United Providers UP&UP |
$76.26
|
| Rate for Payer: Zelis Auto |
$32.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$41.00
|
| Rate for Payer: Zelis Worker's Compensation |
$22.39
|
|
|
NONPHYSICIAN TELEPHONE ASSESSMENT 11-20
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 98967
|
| Hospital Charge Code |
1900051
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$29.76 |
| Max. Negotiated Rate |
$103.55 |
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$92.65
|
| Rate for Payer: First Health Commercial |
$98.10
|
| Rate for Payer: First Health Workers Compensation |
$42.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$98.10
|
| Rate for Payer: GEHA Commercial |
$76.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$98.10
|
| Rate for Payer: Multiplan All |
$99.19
|
| Rate for Payer: OMNI Networks Commercial |
$76.30
|
| Rate for Payer: One Health Plan PPO/POS |
$98.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$103.55
|
| Rate for Payer: Three Rivers Provider Network All |
$81.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$101.37
|
| Rate for Payer: Zelis Auto |
$43.60
|
| Rate for Payer: Zelis Worker's Compensation |
$29.76
|
|
|
NONPHYSICIAN TELEPHONE ASSESSMENT 11-20
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT 98967
|
| Hospital Charge Code |
9098967
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$22.39 |
| Max. Negotiated Rate |
$77.90 |
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cigna Commercial |
$69.70
|
| Rate for Payer: First Health Commercial |
$73.80
|
| Rate for Payer: First Health Workers Compensation |
$31.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$73.80
|
| Rate for Payer: GEHA Commercial |
$57.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$73.80
|
| Rate for Payer: Multiplan All |
$74.62
|
| Rate for Payer: OMNI Networks Commercial |
$57.40
|
| Rate for Payer: One Health Plan PPO/POS |
$73.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$77.90
|
| Rate for Payer: Three Rivers Provider Network All |
$61.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$76.26
|
| Rate for Payer: Zelis Auto |
$32.80
|
| Rate for Payer: Zelis Worker's Compensation |
$22.39
|
|
|
NONPHYSICIAN TELEPHONE ASSESSMENT 11-20
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT 98967
|
| Hospital Charge Code |
25598967
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$22.39 |
| Max. Negotiated Rate |
$77.90 |
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cigna Commercial |
$69.70
|
| Rate for Payer: First Health Commercial |
$73.80
|
| Rate for Payer: First Health Workers Compensation |
$31.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$73.80
|
| Rate for Payer: GEHA Commercial |
$57.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$73.80
|
| Rate for Payer: Multiplan All |
$74.62
|
| Rate for Payer: OMNI Networks Commercial |
$57.40
|
| Rate for Payer: One Health Plan PPO/POS |
$73.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$77.90
|
| Rate for Payer: Three Rivers Provider Network All |
$61.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$76.26
|
| Rate for Payer: Zelis Auto |
$32.80
|
| Rate for Payer: Zelis Worker's Compensation |
$22.39
|
|
|
NONPHYSICIAN TELEPHONE ASSESSMENT 11-20
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 98967
|
| Hospital Charge Code |
8098967
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$21.32 |
| Max. Negotiated Rate |
$77.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$51.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$49.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$51.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$41.15
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cigna Commercial |
$69.70
|
| Rate for Payer: First Health Commercial |
$73.80
|
| Rate for Payer: First Health Workers Compensation |
$31.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$73.80
|
| Rate for Payer: GEHA Commercial |
$65.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$73.80
|
| Rate for Payer: Humana ChoiceCare |
$21.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$41.99
|
| Rate for Payer: Multiplan All |
$74.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$49.20
|
| Rate for Payer: OMNI Networks Commercial |
$57.40
|
| Rate for Payer: One Health Plan PPO/POS |
$73.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$48.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$41.99
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$77.90
|
| Rate for Payer: Three Rivers Provider Network All |
$61.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$72.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$41.99
|
| Rate for Payer: United Payors & United Providers UP&UP |
$76.26
|
| Rate for Payer: Zelis Auto |
$32.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$41.00
|
| Rate for Payer: Zelis Worker's Compensation |
$22.39
|
|
|
NONPHYSICIAN TELEPHONE ASSESSMENT 11-20
|
Facility
|
OP
|
$64.89
|
|
|
Service Code
|
CPT 98967
|
| Hospital Charge Code |
8599501
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$16.87 |
| Max. Negotiated Rate |
$61.65 |
| Rate for Payer: Zelis Worker's Compensation |
$17.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$51.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$38.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$51.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$41.15
|
| Rate for Payer: Cash Price |
$38.93
|
| Rate for Payer: Cash Price |
$38.93
|
| Rate for Payer: Cigna Commercial |
$55.16
|
| Rate for Payer: First Health Commercial |
$58.40
|
| Rate for Payer: First Health Workers Compensation |
$25.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$58.40
|
| Rate for Payer: GEHA Commercial |
$51.91
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$58.40
|
| Rate for Payer: Humana ChoiceCare |
$16.87
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$41.99
|
| Rate for Payer: Multiplan All |
$59.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$38.93
|
| Rate for Payer: OMNI Networks Commercial |
$45.42
|
| Rate for Payer: One Health Plan PPO/POS |
$58.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$48.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$41.99
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$61.65
|
| Rate for Payer: Three Rivers Provider Network All |
$48.67
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$57.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$41.99
|
| Rate for Payer: United Payors & United Providers UP&UP |
$60.35
|
| Rate for Payer: Zelis Auto |
$25.96
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$32.45
|
|
|
NONPHYSICIAN TELEPHONE ASSESSMENT 11-20
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT 98967
|
| Hospital Charge Code |
8998967
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$22.39 |
| Max. Negotiated Rate |
$77.90 |
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cigna Commercial |
$69.70
|
| Rate for Payer: First Health Commercial |
$73.80
|
| Rate for Payer: First Health Workers Compensation |
$31.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$73.80
|
| Rate for Payer: GEHA Commercial |
$57.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$73.80
|
| Rate for Payer: Multiplan All |
$74.62
|
| Rate for Payer: OMNI Networks Commercial |
$57.40
|
| Rate for Payer: One Health Plan PPO/POS |
$73.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$77.90
|
| Rate for Payer: Three Rivers Provider Network All |
$61.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$76.26
|
| Rate for Payer: Zelis Auto |
$32.80
|
| Rate for Payer: Zelis Worker's Compensation |
$22.39
|
|
|
NONPHYSICIAN TELEPHONE ASSESSMENT 11-20
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT 98967
|
| Hospital Charge Code |
24598967
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$22.39 |
| Max. Negotiated Rate |
$77.90 |
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cigna Commercial |
$69.70
|
| Rate for Payer: First Health Commercial |
$73.80
|
| Rate for Payer: First Health Workers Compensation |
$31.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$73.80
|
| Rate for Payer: GEHA Commercial |
$57.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$73.80
|
| Rate for Payer: Multiplan All |
$74.62
|
| Rate for Payer: OMNI Networks Commercial |
$57.40
|
| Rate for Payer: One Health Plan PPO/POS |
$73.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$77.90
|
| Rate for Payer: Three Rivers Provider Network All |
$61.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$76.26
|
| Rate for Payer: Zelis Auto |
$32.80
|
| Rate for Payer: Zelis Worker's Compensation |
$22.39
|
|
|
NONPHYSICIAN TELEPHONE ASSESSMENT 11-20
|
Facility
|
IP
|
$64.89
|
|
|
Service Code
|
CPT 98967
|
| Hospital Charge Code |
8599501
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$17.71 |
| Max. Negotiated Rate |
$61.65 |
| Rate for Payer: Cash Price |
$38.93
|
| Rate for Payer: Cigna Commercial |
$55.16
|
| Rate for Payer: First Health Commercial |
$58.40
|
| Rate for Payer: First Health Workers Compensation |
$25.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$58.40
|
| Rate for Payer: GEHA Commercial |
$45.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$58.40
|
| Rate for Payer: Multiplan All |
$59.05
|
| Rate for Payer: OMNI Networks Commercial |
$45.42
|
| Rate for Payer: One Health Plan PPO/POS |
$58.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$61.65
|
| Rate for Payer: Three Rivers Provider Network All |
$48.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$60.35
|
| Rate for Payer: Zelis Auto |
$25.96
|
| Rate for Payer: Zelis Worker's Compensation |
$17.71
|
|
|
NONPHYSICIAN TELEPHONE ASSESSMENT 11-20
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 98967
|
| Hospital Charge Code |
21599221
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$21.32 |
| Max. Negotiated Rate |
$77.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$51.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$49.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$51.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$41.15
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cigna Commercial |
$69.70
|
| Rate for Payer: First Health Commercial |
$73.80
|
| Rate for Payer: First Health Workers Compensation |
$31.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$73.80
|
| Rate for Payer: GEHA Commercial |
$65.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$73.80
|
| Rate for Payer: Humana ChoiceCare |
$21.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$41.99
|
| Rate for Payer: Multiplan All |
$74.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$49.20
|
| Rate for Payer: OMNI Networks Commercial |
$57.40
|
| Rate for Payer: One Health Plan PPO/POS |
$73.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$48.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$41.99
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$77.90
|
| Rate for Payer: Three Rivers Provider Network All |
$61.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$72.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$41.99
|
| Rate for Payer: United Payors & United Providers UP&UP |
$76.26
|
| Rate for Payer: Zelis Auto |
$32.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$41.00
|
| Rate for Payer: Zelis Worker's Compensation |
$22.39
|
|
