|
NTRPROF PHONE/NTRNET/EHR REFERRAL SVC 30
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 99452
|
| Hospital Charge Code |
20399220
|
|
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 |
$59.63
|
| 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 |
$42.16
|
|
|
NTRPROF PHONE/NTRNET/EHR REFERRAL SVC 30
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 99452
|
| Hospital Charge Code |
20399220
|
|
Hospital Revenue Code
|
424
|
| 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 PHONE/NTRNET/EHR REFERRAL SVC 30
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 99452
|
| Hospital Charge Code |
25500016
|
|
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 PHONE/NTRNET/EHR REFERRAL SVC 30
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
CPT 99452
|
| Hospital Charge Code |
1999219
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$27.75 |
| Max. Negotiated Rate |
$105.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna Commercial |
$94.35
|
| Rate for Payer: First Health Commercial |
$99.90
|
| Rate for Payer: First Health Workers Compensation |
$42.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$99.90
|
| Rate for Payer: GEHA Commercial |
$88.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$99.90
|
| Rate for Payer: Humana ChoiceCare |
$28.86
|
| Rate for Payer: Multiplan All |
$101.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$66.60
|
| Rate for Payer: OMNI Networks Commercial |
$77.70
|
| Rate for Payer: One Health Plan PPO/POS |
$99.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$105.45
|
| Rate for Payer: Three Rivers Provider Network All |
$83.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$97.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$27.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$103.23
|
| Rate for Payer: Zelis Auto |
$44.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$55.50
|
| Rate for Payer: Zelis Worker's Compensation |
$30.30
|
|
|
NTRPROF PHONE/NTRNET/EHR REFERRAL SVC 30
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
CPT 99452
|
| Hospital Charge Code |
1999219
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$30.30 |
| Max. Negotiated Rate |
$105.45 |
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna Commercial |
$94.35
|
| Rate for Payer: First Health Commercial |
$99.90
|
| Rate for Payer: First Health Workers Compensation |
$42.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$99.90
|
| Rate for Payer: GEHA Commercial |
$77.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$99.90
|
| Rate for Payer: Multiplan All |
$101.01
|
| Rate for Payer: OMNI Networks Commercial |
$77.70
|
| Rate for Payer: One Health Plan PPO/POS |
$99.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$105.45
|
| Rate for Payer: Three Rivers Provider Network All |
$83.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$103.23
|
| Rate for Payer: Zelis Auto |
$44.40
|
| Rate for Payer: Zelis Worker's Compensation |
$30.30
|
|
|
NTRPROF PHONE/NTRNET/EHR REFERRAL SVC 30
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 99452
|
| Hospital Charge Code |
21500016
|
|
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 PHONE/NTRNET/EHR REFERRAL SVC 30
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 99452
|
| Hospital Charge Code |
8600013
|
|
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
|
|
|
NTRPROF PHONE/NTRNET/EHR REFERRAL SVC 30
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 99452
|
| Hospital Charge Code |
8600013
|
|
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 PHONE/NTRNET/EHR REFERRAL SVC 30
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 99452
|
| Hospital Charge Code |
9200028
|
|
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 PHONE/NTRNET/EHR REFERRAL SVC 30
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 99452
|
| Hospital Charge Code |
21600016
|
|
Hospital Revenue Code
|
517
|
| 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 PHONE/NTRNET/EHR REFERRAL SVC 30
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 99452
|
| Hospital Charge Code |
9799217
|
|
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 PHONE/NTRNET/EHR REFERRAL SVC 30
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 99452
|
| Hospital Charge Code |
9799217
|
|
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 PHONE/NTRNET/EHR REFERRAL SVC 30
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 99452
|
| Hospital Charge Code |
8500011
|
|
Hospital Revenue Code
|
521
|
| 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 PHONE/NTRNET/EHR REFERRAL SVC 30
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 99452
|
| Hospital Charge Code |
21600016
|
|
Hospital Revenue Code
|
517
|
| 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 PHONE/NTRNET/EHR REFERRAL SVC 30
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 99452
|
| Hospital Charge Code |
21700036
|
|
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 PHONE/NTRNET/EHR REFERRAL SVC 30
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 99452
|
| Hospital Charge Code |
9599219
|
|
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 PHONE/NTRNET/EHR REFERRAL SVC 30
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 99452
|
| Hospital Charge Code |
8250027
|
|
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 PHONE/NTRNET/EHR REFERRAL SVC 30
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 99452
|
| Hospital Charge Code |
8250027
|
|
Hospital Revenue Code
|
320
|
| 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 PHONE/NTRNET/EHR REFERRAL SVC 30
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
CPT 99452
|
| Hospital Charge Code |
11099217
|
|
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 |
$35.04
|
| 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 |
$35.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$29.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$32.97
|
| 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 |
$46.16
|
| Rate for Payer: First Health Workers Compensation |
$59.63
|
| Rate for Payer: GEHA Commercial |
$32.97
|
| Rate for Payer: GEHA Medicare |
$32.97
|
| Rate for Payer: Health Net Federal Services Government |
$32.97
|
| Rate for Payer: HealthSmart Commercial |
$46.16
|
| Rate for Payer: HealthSmart Worker's Compensation |
$57.22
|
| Rate for Payer: Humana ChoiceCare |
$36.27
|
| Rate for Payer: Humana Medicare Advantage |
$32.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$46.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$29.24
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$32.97
|
| 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 |
$60.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$34.62
|
| Rate for Payer: OMNI Networks Commercial |
$79.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$44.32
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$19.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$36.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$71.54
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$32.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.97
|
| Rate for Payer: Zelis Medicare |
$28.02
|
| Rate for Payer: Zelis Worker's Compensation |
$42.16
|
|
|
NTRPROF PHONE/NTRNET/EHR REFERRAL SVC 30
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 99452
|
| Hospital Charge Code |
21700036
|
|
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 PHONE/NTRNET/EHR REFERRAL SVC 30
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 99452
|
| Hospital Charge Code |
9600007
|
|
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 PHONE/NTRNET/EHR REFERRAL SVC 30
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
CPT 99452
|
| Hospital Charge Code |
14099217
|
|
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 |
$35.04
|
| 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 |
$35.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$29.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$32.97
|
| 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 |
$46.16
|
| Rate for Payer: First Health Workers Compensation |
$59.63
|
| Rate for Payer: GEHA Commercial |
$32.97
|
| Rate for Payer: GEHA Medicare |
$32.97
|
| Rate for Payer: Health Net Federal Services Government |
$32.97
|
| Rate for Payer: HealthSmart Commercial |
$46.16
|
| Rate for Payer: HealthSmart Worker's Compensation |
$57.22
|
| Rate for Payer: Humana ChoiceCare |
$36.27
|
| Rate for Payer: Humana Medicare Advantage |
$32.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$46.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$29.24
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$32.97
|
| 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 |
$60.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$34.62
|
| Rate for Payer: OMNI Networks Commercial |
$79.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$44.32
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$19.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$36.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$71.54
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$32.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.97
|
| Rate for Payer: Zelis Medicare |
$28.02
|
| Rate for Payer: Zelis Worker's Compensation |
$42.16
|
|
|
NTRPROF PHONE/NTRNET/EHR REFERRAL SVC 30
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 99452
|
| Hospital Charge Code |
9600007
|
|
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 PHONE/NTRNET/EHR REFERRAL SVC 30
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
CPT 99452
|
| Hospital Charge Code |
10099217
|
|
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 |
$35.04
|
| 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 |
$35.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$29.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$32.97
|
| 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 |
$46.16
|
| Rate for Payer: First Health Workers Compensation |
$59.63
|
| Rate for Payer: GEHA Commercial |
$32.97
|
| Rate for Payer: GEHA Medicare |
$32.97
|
| Rate for Payer: Health Net Federal Services Government |
$32.97
|
| Rate for Payer: HealthSmart Commercial |
$46.16
|
| Rate for Payer: HealthSmart Worker's Compensation |
$57.22
|
| Rate for Payer: Humana ChoiceCare |
$36.27
|
| Rate for Payer: Humana Medicare Advantage |
$32.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$46.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$29.24
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$32.97
|
| 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 |
$60.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$34.62
|
| Rate for Payer: OMNI Networks Commercial |
$79.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$44.32
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$19.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$36.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$71.54
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$32.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.97
|
| Rate for Payer: Zelis Medicare |
$28.02
|
| Rate for Payer: Zelis Worker's Compensation |
$42.16
|
|
|
NUBHVL XM PHY/QHP EA ADDL HR
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
CPT 96121
|
| Hospital Charge Code |
4397910
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$62.66 |
| Max. Negotiated Rate |
$228.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$162.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$144.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$162.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$129.04
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cigna Commercial |
$204.85
|
| Rate for Payer: First Health Commercial |
$216.90
|
| Rate for Payer: First Health Workers Compensation |
$93.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$216.90
|
| Rate for Payer: GEHA Commercial |
$192.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$216.90
|
| Rate for Payer: Humana ChoiceCare |
$62.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$131.67
|
| Rate for Payer: Multiplan All |
$219.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$144.60
|
| Rate for Payer: OMNI Networks Commercial |
$168.70
|
| Rate for Payer: One Health Plan PPO/POS |
$216.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$152.03
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$131.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$228.95
|
| Rate for Payer: Three Rivers Provider Network All |
$180.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$212.08
|
| Rate for Payer: United Healthcare Commercial |
$204.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$131.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$224.13
|
| Rate for Payer: Zelis Auto |
$96.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$120.50
|
| Rate for Payer: Zelis Worker's Compensation |
$65.79
|
|
