|
NTRPROF PH1/NTRNET/EHR 5/>
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
CPT 99451
|
| Hospital Charge Code |
12099216
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.95 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$34.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$33.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$34.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$30.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$32.38
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$67.80
|
| Rate for Payer: Cimarron Advantage Cimarron Advantage PPO |
$45.33
|
| Rate for Payer: First Health Workers Compensation |
$61.44
|
| Rate for Payer: GEHA Commercial |
$32.38
|
| Rate for Payer: GEHA Medicare |
$32.38
|
| Rate for Payer: Health Net Federal Services Government |
$32.38
|
| Rate for Payer: HealthSmart Commercial |
$45.33
|
| Rate for Payer: HealthSmart Worker's Compensation |
$58.96
|
| Rate for Payer: Humana ChoiceCare |
$35.62
|
| Rate for Payer: Humana Medicare Advantage |
$32.38
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$45.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$30.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$32.38
|
| Rate for Payer: Multiplan All |
$84.75
|
| Rate for Payer: National Preferred Provider Network Commercial |
$107.35
|
| Rate for Payer: National Preferred Provider Network Worker's Compensation |
$62.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$34.00
|
| Rate for Payer: OMNI Networks Commercial |
$79.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$43.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$19.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$35.54
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$70.26
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$31.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.38
|
| Rate for Payer: Zelis Medicare |
$27.52
|
| Rate for Payer: Zelis Worker's Compensation |
$43.44
|
|
|
NTRPROF PH1/NTRNET/EHR 5/>
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 99451
|
| Hospital Charge Code |
8500010
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$30.85 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$96.05
|
| Rate for Payer: First Health Commercial |
$101.70
|
| Rate for Payer: First Health Workers Compensation |
$43.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$101.70
|
| Rate for Payer: GEHA Commercial |
$79.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$101.70
|
| Rate for Payer: Multiplan All |
$102.83
|
| Rate for Payer: OMNI Networks Commercial |
$79.10
|
| Rate for Payer: One Health Plan PPO/POS |
$101.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$107.35
|
| Rate for Payer: Three Rivers Provider Network All |
$84.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$105.09
|
| Rate for Payer: Zelis Auto |
$45.20
|
| Rate for Payer: Zelis Worker's Compensation |
$30.85
|
|
|
NTRPROF PH1/NTRNET/EHR 5/>
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
CPT 99451
|
| Hospital Charge Code |
14099216
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.95 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$34.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$33.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$34.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$30.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$32.38
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$67.80
|
| Rate for Payer: Cimarron Advantage Cimarron Advantage PPO |
$45.33
|
| Rate for Payer: First Health Workers Compensation |
$61.44
|
| Rate for Payer: GEHA Commercial |
$32.38
|
| Rate for Payer: GEHA Medicare |
$32.38
|
| Rate for Payer: Health Net Federal Services Government |
$32.38
|
| Rate for Payer: HealthSmart Commercial |
$45.33
|
| Rate for Payer: HealthSmart Worker's Compensation |
$58.96
|
| Rate for Payer: Humana ChoiceCare |
$35.62
|
| Rate for Payer: Humana Medicare Advantage |
$32.38
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$45.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$30.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$32.38
|
| Rate for Payer: Multiplan All |
$84.75
|
| Rate for Payer: National Preferred Provider Network Commercial |
$107.35
|
| Rate for Payer: National Preferred Provider Network Worker's Compensation |
$62.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$34.00
|
| Rate for Payer: OMNI Networks Commercial |
$79.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$43.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$19.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$35.54
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$70.26
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$31.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.38
|
| Rate for Payer: Zelis Medicare |
$27.52
|
| Rate for Payer: Zelis Worker's Compensation |
$43.44
|
|
|
NTRPROF PH1/NTRNET/EHR 5/>
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 99451
|
| Hospital Charge Code |
9799216
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$28.25 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$96.05
|
| Rate for Payer: First Health Commercial |
$101.70
|
| Rate for Payer: First Health Workers Compensation |
$43.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$101.70
|
| Rate for Payer: GEHA Commercial |
$90.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$101.70
|
| Rate for Payer: Humana ChoiceCare |
$29.38
|
| Rate for Payer: Multiplan All |
$102.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$67.80
|
| Rate for Payer: OMNI Networks Commercial |
$79.10
|
| Rate for Payer: One Health Plan PPO/POS |
$101.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$107.35
|
| Rate for Payer: Three Rivers Provider Network All |
$84.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$99.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$28.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$105.09
|
| Rate for Payer: Zelis Auto |
$45.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$56.50
|
| Rate for Payer: Zelis Worker's Compensation |
$30.85
|
|
|
NTRPROF PH1/NTRNET/EHR 5/>
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 99451
|
| Hospital Charge Code |
8000005
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$28.25 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$96.05
|
| Rate for Payer: First Health Commercial |
$101.70
|
| Rate for Payer: First Health Workers Compensation |
$43.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$101.70
|
| Rate for Payer: GEHA Commercial |
$90.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$101.70
|
| Rate for Payer: Humana ChoiceCare |
$29.38
|
| Rate for Payer: Multiplan All |
$102.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$67.80
|
| Rate for Payer: OMNI Networks Commercial |
$79.10
|
| Rate for Payer: One Health Plan PPO/POS |
$101.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$107.35
|
| Rate for Payer: Three Rivers Provider Network All |
$84.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$99.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$28.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$105.09
|
| Rate for Payer: Zelis Auto |
$45.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$56.50
|
| Rate for Payer: Zelis Worker's Compensation |
$30.85
|
|
|
NTRPROF PH1/NTRNET/EHR 5/>
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
CPT 99451
|
| Hospital Charge Code |
11099216
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.95 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$34.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$33.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$34.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$30.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$32.38
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$67.80
|
| Rate for Payer: Cimarron Advantage Cimarron Advantage PPO |
$45.33
|
| Rate for Payer: First Health Workers Compensation |
$61.44
|
| Rate for Payer: GEHA Commercial |
$32.38
|
| Rate for Payer: GEHA Medicare |
$32.38
|
| Rate for Payer: Health Net Federal Services Government |
$32.38
|
| Rate for Payer: HealthSmart Commercial |
$45.33
|
| Rate for Payer: HealthSmart Worker's Compensation |
$58.96
|
| Rate for Payer: Humana ChoiceCare |
$35.62
|
| Rate for Payer: Humana Medicare Advantage |
$32.38
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$45.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$30.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$32.38
|
| Rate for Payer: Multiplan All |
$84.75
|
| Rate for Payer: National Preferred Provider Network Commercial |
$107.35
|
| Rate for Payer: National Preferred Provider Network Worker's Compensation |
$62.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$34.00
|
| Rate for Payer: OMNI Networks Commercial |
$79.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$43.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$19.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$35.54
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$70.26
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$31.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.38
|
| Rate for Payer: Zelis Medicare |
$27.52
|
| Rate for Payer: Zelis Worker's Compensation |
$43.44
|
|
|
NTRPROF PH1/NTRNET/EHR 5/>
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
CPT 99451
|
| Hospital Charge Code |
10099216
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.95 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$34.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$33.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$34.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$30.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$32.38
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$67.80
|
| Rate for Payer: Cimarron Advantage Cimarron Advantage PPO |
$45.33
|
| Rate for Payer: First Health Workers Compensation |
$61.44
|
| Rate for Payer: GEHA Commercial |
$32.38
|
| Rate for Payer: GEHA Medicare |
$32.38
|
| Rate for Payer: Health Net Federal Services Government |
$32.38
|
| Rate for Payer: HealthSmart Commercial |
$45.33
|
| Rate for Payer: HealthSmart Worker's Compensation |
$58.96
|
| Rate for Payer: Humana ChoiceCare |
$35.62
|
| Rate for Payer: Humana Medicare Advantage |
$32.38
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$45.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$30.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$32.38
|
| Rate for Payer: Multiplan All |
$84.75
|
| Rate for Payer: National Preferred Provider Network Commercial |
$107.35
|
| Rate for Payer: National Preferred Provider Network Worker's Compensation |
$62.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$34.00
|
| Rate for Payer: OMNI Networks Commercial |
$79.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$43.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$19.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$35.54
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$70.26
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$31.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.38
|
| Rate for Payer: Zelis Medicare |
$27.52
|
| Rate for Payer: Zelis Worker's Compensation |
$43.44
|
|
|
NTRPROF PH1/NTRNET/EHR 5/>
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 99451
|
| Hospital Charge Code |
7599216
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.85 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$96.05
|
| Rate for Payer: First Health Commercial |
$101.70
|
| Rate for Payer: First Health Workers Compensation |
$43.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$101.70
|
| Rate for Payer: GEHA Commercial |
$79.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$101.70
|
| Rate for Payer: Multiplan All |
$102.83
|
| Rate for Payer: OMNI Networks Commercial |
$79.10
|
| Rate for Payer: One Health Plan PPO/POS |
$101.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$107.35
|
| Rate for Payer: Three Rivers Provider Network All |
$84.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$105.09
|
| Rate for Payer: Zelis Auto |
$45.20
|
| Rate for Payer: Zelis Worker's Compensation |
$30.85
|
|
|
NTRPROF PH1/NTRNET/EHR 5/>
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 99451
|
| Hospital Charge Code |
8499218
|
|
Hospital Revenue Code
|
513
|
| Min. Negotiated Rate |
$30.85 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$96.05
|
| Rate for Payer: First Health Commercial |
$101.70
|
| Rate for Payer: First Health Workers Compensation |
$43.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$101.70
|
| Rate for Payer: GEHA Commercial |
$79.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$101.70
|
| Rate for Payer: Multiplan All |
$102.83
|
| Rate for Payer: OMNI Networks Commercial |
$79.10
|
| Rate for Payer: One Health Plan PPO/POS |
$101.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$107.35
|
| Rate for Payer: Three Rivers Provider Network All |
$84.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$105.09
|
| Rate for Payer: Zelis Auto |
$45.20
|
| Rate for Payer: Zelis Worker's Compensation |
$30.85
|
|
|
NTRPROF PH1/NTRNET/EHR 5/>
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 99451
|
| Hospital Charge Code |
21700035
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$28.25 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$96.05
|
| Rate for Payer: First Health Commercial |
$101.70
|
| Rate for Payer: First Health Workers Compensation |
$43.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$101.70
|
| Rate for Payer: GEHA Commercial |
$90.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$101.70
|
| Rate for Payer: Humana ChoiceCare |
$29.38
|
| Rate for Payer: Multiplan All |
$102.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$67.80
|
| Rate for Payer: OMNI Networks Commercial |
$79.10
|
| Rate for Payer: One Health Plan PPO/POS |
$101.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$107.35
|
| Rate for Payer: Three Rivers Provider Network All |
$84.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$99.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$28.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$105.09
|
| Rate for Payer: Zelis Auto |
$45.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$56.50
|
| Rate for Payer: Zelis Worker's Compensation |
$30.85
|
|
|
NTRPROF PH1/NTRNET/EHR 5/>
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 99451
|
| Hospital Charge Code |
8000005
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.85 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$96.05
|
| Rate for Payer: First Health Commercial |
$101.70
|
| Rate for Payer: First Health Workers Compensation |
$43.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$101.70
|
| Rate for Payer: GEHA Commercial |
$79.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$101.70
|
| Rate for Payer: Multiplan All |
$102.83
|
| Rate for Payer: OMNI Networks Commercial |
$79.10
|
| Rate for Payer: One Health Plan PPO/POS |
$101.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$107.35
|
| Rate for Payer: Three Rivers Provider Network All |
$84.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$105.09
|
| Rate for Payer: Zelis Auto |
$45.20
|
| Rate for Payer: Zelis Worker's Compensation |
$30.85
|
|
|
NTRPROF PH1/NTRNET/EHR 5/>
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 99451
|
| Hospital Charge Code |
8300068
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$30.85 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$96.05
|
| Rate for Payer: First Health Commercial |
$101.70
|
| Rate for Payer: First Health Workers Compensation |
$43.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$101.70
|
| Rate for Payer: GEHA Commercial |
$79.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$101.70
|
| Rate for Payer: Multiplan All |
$102.83
|
| Rate for Payer: OMNI Networks Commercial |
$79.10
|
| Rate for Payer: One Health Plan PPO/POS |
$101.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$107.35
|
| Rate for Payer: Three Rivers Provider Network All |
$84.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$105.09
|
| Rate for Payer: Zelis Auto |
$45.20
|
| Rate for Payer: Zelis Worker's Compensation |
$30.85
|
|
|
NTRPROF PH1/NTRNET/EHR 5/>
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 99451
|
| Hospital Charge Code |
8600012
|
|
Hospital Revenue Code
|
985
|
| Min. Negotiated Rate |
$30.85 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$96.05
|
| Rate for Payer: First Health Commercial |
$101.70
|
| Rate for Payer: First Health Workers Compensation |
$43.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$101.70
|
| Rate for Payer: GEHA Commercial |
$79.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$101.70
|
| Rate for Payer: Multiplan All |
$102.83
|
| Rate for Payer: OMNI Networks Commercial |
$79.10
|
| Rate for Payer: One Health Plan PPO/POS |
$101.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$107.35
|
| Rate for Payer: Three Rivers Provider Network All |
$84.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$105.09
|
| Rate for Payer: Zelis Auto |
$45.20
|
| Rate for Payer: Zelis Worker's Compensation |
$30.85
|
|
|
NTRPROF PH1/NTRNET/EHR 5/>
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 99451
|
| Hospital Charge Code |
1999218
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$27.25 |
| Max. Negotiated Rate |
$103.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$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: 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: 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 |
$27.25
|
| 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
|
|
|
NTRPROF PH1/NTRNET/EHR 5/>
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 99451
|
| Hospital Charge Code |
21000001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$28.25 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$96.05
|
| Rate for Payer: First Health Commercial |
$101.70
|
| Rate for Payer: First Health Workers Compensation |
$43.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$101.70
|
| Rate for Payer: GEHA Commercial |
$90.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$101.70
|
| Rate for Payer: Humana ChoiceCare |
$29.38
|
| Rate for Payer: Multiplan All |
$102.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$67.80
|
| Rate for Payer: OMNI Networks Commercial |
$79.10
|
| Rate for Payer: One Health Plan PPO/POS |
$101.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$107.35
|
| Rate for Payer: Three Rivers Provider Network All |
$84.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$99.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$28.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$105.09
|
| Rate for Payer: Zelis Auto |
$45.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$56.50
|
| Rate for Payer: Zelis Worker's Compensation |
$30.85
|
|
|
NTRPROF PH1/NTRNET/EHR 5/>
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 99451
|
| Hospital Charge Code |
20399219
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$28.25 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$96.05
|
| Rate for Payer: First Health Commercial |
$101.70
|
| Rate for Payer: First Health Workers Compensation |
$61.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$101.70
|
| Rate for Payer: GEHA Commercial |
$90.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$101.70
|
| Rate for Payer: Humana ChoiceCare |
$29.38
|
| Rate for Payer: Multiplan All |
$102.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$67.80
|
| Rate for Payer: OMNI Networks Commercial |
$79.10
|
| Rate for Payer: One Health Plan PPO/POS |
$101.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$107.35
|
| Rate for Payer: Three Rivers Provider Network All |
$84.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$99.44
|
| Rate for Payer: United Healthcare Commercial |
$96.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$28.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$105.09
|
| Rate for Payer: Zelis Auto |
$45.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$56.50
|
| Rate for Payer: Zelis Worker's Compensation |
$43.44
|
|
|
NTRPROF PH1/NTRNET/EHR 5/>
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 99451
|
| Hospital Charge Code |
21500015
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.85 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$96.05
|
| Rate for Payer: First Health Commercial |
$101.70
|
| Rate for Payer: First Health Workers Compensation |
$43.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$101.70
|
| Rate for Payer: GEHA Commercial |
$79.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$101.70
|
| Rate for Payer: Multiplan All |
$102.83
|
| Rate for Payer: OMNI Networks Commercial |
$79.10
|
| Rate for Payer: One Health Plan PPO/POS |
$101.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$107.35
|
| Rate for Payer: Three Rivers Provider Network All |
$84.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$105.09
|
| Rate for Payer: Zelis Auto |
$45.20
|
| Rate for Payer: Zelis Worker's Compensation |
$30.85
|
|
|
NTRPROF PH1/NTRNET/EHR 5/>
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 99451
|
| Hospital Charge Code |
9200027
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$30.85 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$96.05
|
| Rate for Payer: First Health Commercial |
$101.70
|
| Rate for Payer: First Health Workers Compensation |
$43.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$101.70
|
| Rate for Payer: GEHA Commercial |
$79.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$101.70
|
| Rate for Payer: Multiplan All |
$102.83
|
| Rate for Payer: OMNI Networks Commercial |
$79.10
|
| Rate for Payer: One Health Plan PPO/POS |
$101.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$107.35
|
| Rate for Payer: Three Rivers Provider Network All |
$84.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$105.09
|
| Rate for Payer: Zelis Auto |
$45.20
|
| Rate for Payer: Zelis Worker's Compensation |
$30.85
|
|
|
NTRPROF PH1/NTRNET/EHR 5/>
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 99451
|
| Hospital Charge Code |
21500015
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$28.25 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$96.05
|
| Rate for Payer: First Health Commercial |
$101.70
|
| Rate for Payer: First Health Workers Compensation |
$43.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$101.70
|
| Rate for Payer: GEHA Commercial |
$90.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$101.70
|
| Rate for Payer: Humana ChoiceCare |
$29.38
|
| Rate for Payer: Multiplan All |
$102.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$67.80
|
| Rate for Payer: OMNI Networks Commercial |
$79.10
|
| Rate for Payer: One Health Plan PPO/POS |
$101.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$107.35
|
| Rate for Payer: Three Rivers Provider Network All |
$84.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$99.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$28.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$105.09
|
| Rate for Payer: Zelis Auto |
$45.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$56.50
|
| Rate for Payer: Zelis Worker's Compensation |
$30.85
|
|
|
NTRPROF PH1/NTRNET/EHR 5/>
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 99451
|
| Hospital Charge Code |
8250026
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.25 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$96.05
|
| Rate for Payer: First Health Commercial |
$101.70
|
| Rate for Payer: First Health Workers Compensation |
$43.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$101.70
|
| Rate for Payer: GEHA Commercial |
$90.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$101.70
|
| Rate for Payer: Humana ChoiceCare |
$29.38
|
| Rate for Payer: Multiplan All |
$102.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$67.80
|
| Rate for Payer: OMNI Networks Commercial |
$79.10
|
| Rate for Payer: One Health Plan PPO/POS |
$101.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$107.35
|
| Rate for Payer: Three Rivers Provider Network All |
$84.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$99.44
|
| Rate for Payer: United Healthcare Commercial |
$96.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$28.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$105.09
|
| Rate for Payer: Zelis Auto |
$45.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$56.50
|
| Rate for Payer: Zelis Worker's Compensation |
$30.85
|
|
|
NTRPROF PH1/NTRNET/EHR 5/>
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 99451
|
| Hospital Charge Code |
9200027
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$28.25 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$96.05
|
| Rate for Payer: First Health Commercial |
$101.70
|
| Rate for Payer: First Health Workers Compensation |
$43.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$101.70
|
| Rate for Payer: GEHA Commercial |
$90.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$101.70
|
| Rate for Payer: Humana ChoiceCare |
$29.38
|
| Rate for Payer: Multiplan All |
$102.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$67.80
|
| Rate for Payer: OMNI Networks Commercial |
$79.10
|
| Rate for Payer: One Health Plan PPO/POS |
$101.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$107.35
|
| Rate for Payer: Three Rivers Provider Network All |
$84.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$99.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$28.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$105.09
|
| Rate for Payer: Zelis Auto |
$45.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$56.50
|
| Rate for Payer: Zelis Worker's Compensation |
$30.85
|
|
|
NTRPROF PH1/NTRNET/EHR 5/>
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 99451
|
| Hospital Charge Code |
9399216
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$28.25 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$96.05
|
| Rate for Payer: First Health Commercial |
$101.70
|
| Rate for Payer: First Health Workers Compensation |
$43.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$101.70
|
| Rate for Payer: GEHA Commercial |
$90.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$101.70
|
| Rate for Payer: Humana ChoiceCare |
$29.38
|
| Rate for Payer: Multiplan All |
$102.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$67.80
|
| Rate for Payer: OMNI Networks Commercial |
$79.10
|
| Rate for Payer: One Health Plan PPO/POS |
$101.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$107.35
|
| Rate for Payer: Three Rivers Provider Network All |
$84.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$99.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$28.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$105.09
|
| Rate for Payer: Zelis Auto |
$45.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$56.50
|
| Rate for Payer: Zelis Worker's Compensation |
$30.85
|
|
|
NTRPROF PH1/NTRNET/EHR 5/>
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 99451
|
| Hospital Charge Code |
9000026
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$28.25 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$96.05
|
| Rate for Payer: First Health Commercial |
$101.70
|
| Rate for Payer: First Health Workers Compensation |
$43.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$101.70
|
| Rate for Payer: GEHA Commercial |
$90.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$101.70
|
| Rate for Payer: Humana ChoiceCare |
$29.38
|
| Rate for Payer: Multiplan All |
$102.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$67.80
|
| Rate for Payer: OMNI Networks Commercial |
$79.10
|
| Rate for Payer: One Health Plan PPO/POS |
$101.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$107.35
|
| Rate for Payer: Three Rivers Provider Network All |
$84.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$99.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$28.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$105.09
|
| Rate for Payer: Zelis Auto |
$45.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$56.50
|
| Rate for Payer: Zelis Worker's Compensation |
$30.85
|
|
|
NTRPROF PH1/NTRNET/EHR 5/>
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 99451
|
| Hospital Charge Code |
8900027
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.85 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$96.05
|
| Rate for Payer: First Health Commercial |
$101.70
|
| Rate for Payer: First Health Workers Compensation |
$43.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$101.70
|
| Rate for Payer: GEHA Commercial |
$79.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$101.70
|
| Rate for Payer: Multiplan All |
$102.83
|
| Rate for Payer: OMNI Networks Commercial |
$79.10
|
| Rate for Payer: One Health Plan PPO/POS |
$101.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$107.35
|
| Rate for Payer: Three Rivers Provider Network All |
$84.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$105.09
|
| Rate for Payer: Zelis Auto |
$45.20
|
| Rate for Payer: Zelis Worker's Compensation |
$30.85
|
|
|
NTRPROF PH1/NTRNET/EHR 5/>
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 99451
|
| Hospital Charge Code |
8600012
|
|
Hospital Revenue Code
|
985
|
| Min. Negotiated Rate |
$28.25 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$96.05
|
| Rate for Payer: First Health Commercial |
$101.70
|
| Rate for Payer: First Health Workers Compensation |
$43.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$101.70
|
| Rate for Payer: GEHA Commercial |
$90.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$101.70
|
| Rate for Payer: Humana ChoiceCare |
$29.38
|
| Rate for Payer: Multiplan All |
$102.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$67.80
|
| Rate for Payer: OMNI Networks Commercial |
$79.10
|
| Rate for Payer: One Health Plan PPO/POS |
$101.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$107.35
|
| Rate for Payer: Three Rivers Provider Network All |
$84.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$99.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$28.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$105.09
|
| Rate for Payer: Zelis Auto |
$45.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$56.50
|
| Rate for Payer: Zelis Worker's Compensation |
$30.85
|
|
