|
NONPHYSICIAN TELEPHONE ASSESSMENT 11-20
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 98967
|
| Hospital Charge Code |
1900051
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$28.34 |
| Max. Negotiated Rate |
$103.55 |
| 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 |
$65.40
|
| 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 |
$65.40
|
| 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 |
$87.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$98.10
|
| Rate for Payer: Humana ChoiceCare |
$28.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$41.99
|
| Rate for Payer: Multiplan All |
$99.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$65.40
|
| Rate for Payer: OMNI Networks Commercial |
$76.30
|
| Rate for Payer: One Health Plan PPO/POS |
$98.10
|
| 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 |
$103.55
|
| Rate for Payer: Three Rivers Provider Network All |
$81.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$95.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$41.99
|
| Rate for Payer: United Payors & United Providers UP&UP |
$101.37
|
| Rate for Payer: Zelis Auto |
$43.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$54.50
|
| Rate for Payer: Zelis Worker's Compensation |
$29.76
|
|
|
NONPHYSICIAN TELEPHONE ASSESSMENT 11-20
|
Facility
|
OP
|
$64.89
|
|
|
Service Code
|
CPT 98967
|
| Hospital Charge Code |
7298967
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$16.87 |
| Max. Negotiated Rate |
$61.65 |
| 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
|
| 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 |
9398967
|
|
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
|
$82.00
|
|
|
Service Code
|
CPT 98967
|
| Hospital Charge Code |
20398967
|
|
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 |
9598967
|
|
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 |
8798967
|
|
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
|
$82.00
|
|
|
Service Code
|
CPT 98967
|
| Hospital Charge Code |
9298967
|
|
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 |
7500048
|
|
Hospital Revenue Code
|
510
|
| 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 |
7500048
|
|
Hospital Revenue Code
|
510
|
| 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
|
$82.00
|
|
|
Service Code
|
CPT 98967
|
| Hospital Charge Code |
7600004
|
|
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 |
9498967
|
|
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 |
8798967
|
|
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 |
9598967
|
|
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
|
$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
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 98967
|
| Hospital Charge Code |
9498967
|
|
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 |
9298967
|
|
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 |
9698967
|
|
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 |
7298967
|
|
Hospital Revenue Code
|
517
|
| 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 21-30
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT 98968
|
| Hospital Charge Code |
8798968
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$31.72 |
| Max. Negotiated Rate |
$115.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$71.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$73.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$71.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$56.80
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$103.70
|
| Rate for Payer: First Health Commercial |
$109.80
|
| Rate for Payer: First Health Workers Compensation |
$47.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$109.80
|
| Rate for Payer: GEHA Commercial |
$97.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$109.80
|
| Rate for Payer: Humana ChoiceCare |
$31.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$57.96
|
| Rate for Payer: Multiplan All |
$111.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$73.20
|
| Rate for Payer: OMNI Networks Commercial |
$85.40
|
| Rate for Payer: One Health Plan PPO/POS |
$109.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$66.92
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$57.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$115.90
|
| Rate for Payer: Three Rivers Provider Network All |
$91.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$107.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$57.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$113.46
|
| Rate for Payer: Zelis Auto |
$48.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$61.00
|
| Rate for Payer: Zelis Worker's Compensation |
$33.31
|
|
|
NONPHYSICIAN TELEPHONE ASSESSMENT 21-30
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT 98968
|
| Hospital Charge Code |
9598968
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$31.72 |
| Max. Negotiated Rate |
$115.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$71.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$73.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$71.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$56.80
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$103.70
|
| Rate for Payer: First Health Commercial |
$109.80
|
| Rate for Payer: First Health Workers Compensation |
$47.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$109.80
|
| Rate for Payer: GEHA Commercial |
$97.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$109.80
|
| Rate for Payer: Humana ChoiceCare |
$31.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$57.96
|
| Rate for Payer: Multiplan All |
$111.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$73.20
|
| Rate for Payer: OMNI Networks Commercial |
$85.40
|
| Rate for Payer: One Health Plan PPO/POS |
$109.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$66.92
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$57.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$115.90
|
| Rate for Payer: Three Rivers Provider Network All |
$91.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$107.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$57.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$113.46
|
| Rate for Payer: Zelis Auto |
$48.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$61.00
|
| Rate for Payer: Zelis Worker's Compensation |
$33.31
|
|
|
NONPHYSICIAN TELEPHONE ASSESSMENT 21-30
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT 98968
|
| Hospital Charge Code |
9798968
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$31.72 |
| Max. Negotiated Rate |
$115.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$71.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$73.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$71.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$56.80
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$103.70
|
| Rate for Payer: First Health Commercial |
$109.80
|
| Rate for Payer: First Health Workers Compensation |
$47.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$109.80
|
| Rate for Payer: GEHA Commercial |
$97.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$109.80
|
| Rate for Payer: Humana ChoiceCare |
$31.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$57.96
|
| Rate for Payer: Multiplan All |
$111.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$73.20
|
| Rate for Payer: OMNI Networks Commercial |
$85.40
|
| Rate for Payer: One Health Plan PPO/POS |
$109.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$66.92
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$57.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$115.90
|
| Rate for Payer: Three Rivers Provider Network All |
$91.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$107.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$57.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$113.46
|
| Rate for Payer: Zelis Auto |
$48.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$61.00
|
| Rate for Payer: Zelis Worker's Compensation |
$33.31
|
|
|
NONPHYSICIAN TELEPHONE ASSESSMENT 21-30
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT 98968
|
| Hospital Charge Code |
9398968
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$31.72 |
| Max. Negotiated Rate |
$115.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$71.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$73.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$71.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$56.80
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$103.70
|
| Rate for Payer: First Health Commercial |
$109.80
|
| Rate for Payer: First Health Workers Compensation |
$47.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$109.80
|
| Rate for Payer: GEHA Commercial |
$97.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$109.80
|
| Rate for Payer: Humana ChoiceCare |
$31.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$57.96
|
| Rate for Payer: Multiplan All |
$111.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$73.20
|
| Rate for Payer: OMNI Networks Commercial |
$85.40
|
| Rate for Payer: One Health Plan PPO/POS |
$109.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$66.92
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$57.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$115.90
|
| Rate for Payer: Three Rivers Provider Network All |
$91.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$107.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$57.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$113.46
|
| Rate for Payer: Zelis Auto |
$48.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$61.00
|
| Rate for Payer: Zelis Worker's Compensation |
$33.31
|
|
|
NONPHYSICIAN TELEPHONE ASSESSMENT 21-30
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT 98968
|
| Hospital Charge Code |
9498968
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$31.72 |
| Max. Negotiated Rate |
$115.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$71.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$73.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$71.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$56.80
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$103.70
|
| Rate for Payer: First Health Commercial |
$109.80
|
| Rate for Payer: First Health Workers Compensation |
$47.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$109.80
|
| Rate for Payer: GEHA Commercial |
$97.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$109.80
|
| Rate for Payer: Humana ChoiceCare |
$31.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$57.96
|
| Rate for Payer: Multiplan All |
$111.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$73.20
|
| Rate for Payer: OMNI Networks Commercial |
$85.40
|
| Rate for Payer: One Health Plan PPO/POS |
$109.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$66.92
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$57.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$115.90
|
| Rate for Payer: Three Rivers Provider Network All |
$91.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$107.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$57.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$113.46
|
| Rate for Payer: Zelis Auto |
$48.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$61.00
|
| Rate for Payer: Zelis Worker's Compensation |
$33.31
|
|
|
NONPHYSICIAN TELEPHONE ASSESSMENT 21-30
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT 98968
|
| Hospital Charge Code |
9098968
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$33.31 |
| Max. Negotiated Rate |
$115.90 |
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$103.70
|
| Rate for Payer: First Health Commercial |
$109.80
|
| Rate for Payer: First Health Workers Compensation |
$47.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$109.80
|
| Rate for Payer: GEHA Commercial |
$85.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$109.80
|
| Rate for Payer: Multiplan All |
$111.02
|
| Rate for Payer: OMNI Networks Commercial |
$85.40
|
| Rate for Payer: One Health Plan PPO/POS |
$109.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$115.90
|
| Rate for Payer: Three Rivers Provider Network All |
$91.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$113.46
|
| Rate for Payer: Zelis Auto |
$48.80
|
| Rate for Payer: Zelis Worker's Compensation |
$33.31
|
|
|
NONPHYSICIAN TELEPHONE ASSESSMENT 21-30
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT 98968
|
| Hospital Charge Code |
9598968
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$33.31 |
| Max. Negotiated Rate |
$115.90 |
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$103.70
|
| Rate for Payer: First Health Commercial |
$109.80
|
| Rate for Payer: First Health Workers Compensation |
$47.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$109.80
|
| Rate for Payer: GEHA Commercial |
$85.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$109.80
|
| Rate for Payer: Multiplan All |
$111.02
|
| Rate for Payer: OMNI Networks Commercial |
$85.40
|
| Rate for Payer: One Health Plan PPO/POS |
$109.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$115.90
|
| Rate for Payer: Three Rivers Provider Network All |
$91.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$113.46
|
| Rate for Payer: Zelis Auto |
$48.80
|
| Rate for Payer: Zelis Worker's Compensation |
$33.31
|
|
