|
OFF/OTHR OP CONS NEW/ESTAB; 40 MINS OR M
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
CPT 99244
|
| Hospital Charge Code |
8399244
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$111.38 |
| Max. Negotiated Rate |
$387.60 |
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cigna Commercial |
$346.80
|
| Rate for Payer: First Health Commercial |
$367.20
|
| Rate for Payer: First Health Workers Compensation |
$157.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$367.20
|
| Rate for Payer: GEHA Commercial |
$285.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$367.20
|
| Rate for Payer: Multiplan All |
$371.28
|
| Rate for Payer: OMNI Networks Commercial |
$285.60
|
| Rate for Payer: One Health Plan PPO/POS |
$367.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$387.60
|
| Rate for Payer: Three Rivers Provider Network All |
$306.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$379.44
|
| Rate for Payer: Zelis Auto |
$163.20
|
| Rate for Payer: Zelis Worker's Compensation |
$111.38
|
|
|
OFF/OTHR OP CONS NEW/ESTAB; 40 MINS OR M
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
CPT 99244
|
| Hospital Charge Code |
21999244
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$111.38 |
| Max. Negotiated Rate |
$387.60 |
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cigna Commercial |
$346.80
|
| Rate for Payer: First Health Commercial |
$367.20
|
| Rate for Payer: First Health Workers Compensation |
$157.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$367.20
|
| Rate for Payer: GEHA Commercial |
$285.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$367.20
|
| Rate for Payer: Multiplan All |
$371.28
|
| Rate for Payer: OMNI Networks Commercial |
$285.60
|
| Rate for Payer: One Health Plan PPO/POS |
$367.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$387.60
|
| Rate for Payer: Three Rivers Provider Network All |
$306.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$379.44
|
| Rate for Payer: Zelis Auto |
$163.20
|
| Rate for Payer: Zelis Worker's Compensation |
$111.38
|
|
|
OFF/OTHR OP CONS NEW/ESTAB; 55 MINS OR M
|
Facility
|
OP
|
$515.00
|
|
|
Service Code
|
CPT 99245
|
| Hospital Charge Code |
21599245
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$128.75 |
| Max. Negotiated Rate |
$489.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$309.00
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$437.75
|
| Rate for Payer: First Health Commercial |
$463.50
|
| Rate for Payer: First Health Workers Compensation |
$198.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$463.50
|
| Rate for Payer: GEHA Commercial |
$412.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$463.50
|
| Rate for Payer: Humana ChoiceCare |
$133.90
|
| Rate for Payer: Multiplan All |
$468.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$309.00
|
| Rate for Payer: OMNI Networks Commercial |
$360.50
|
| Rate for Payer: One Health Plan PPO/POS |
$463.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$489.25
|
| Rate for Payer: Three Rivers Provider Network All |
$386.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$453.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$128.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$478.95
|
| Rate for Payer: Zelis Auto |
$206.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$257.50
|
| Rate for Payer: Zelis Worker's Compensation |
$140.59
|
|
|
OFF/OTHR OP CONS NEW/ESTAB; 55 MINS OR M
|
Facility
|
IP
|
$515.00
|
|
|
Service Code
|
CPT 99245
|
| Hospital Charge Code |
21799245
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$140.59 |
| Max. Negotiated Rate |
$489.25 |
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$437.75
|
| Rate for Payer: First Health Commercial |
$463.50
|
| Rate for Payer: First Health Workers Compensation |
$198.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$463.50
|
| Rate for Payer: GEHA Commercial |
$360.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$463.50
|
| Rate for Payer: Multiplan All |
$468.65
|
| Rate for Payer: OMNI Networks Commercial |
$360.50
|
| Rate for Payer: One Health Plan PPO/POS |
$463.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$489.25
|
| Rate for Payer: Three Rivers Provider Network All |
$386.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$478.95
|
| Rate for Payer: Zelis Auto |
$206.00
|
| Rate for Payer: Zelis Worker's Compensation |
$140.59
|
|
|
OFF/OTHR OP CONS NEW/ESTAB; 55 MINS OR M
|
Facility
|
IP
|
$363.90
|
|
|
Service Code
|
CPT 99245
|
| Hospital Charge Code |
8599245
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$99.34 |
| Max. Negotiated Rate |
$345.70 |
| Rate for Payer: Cash Price |
$218.34
|
| Rate for Payer: Cigna Commercial |
$309.31
|
| Rate for Payer: First Health Commercial |
$327.51
|
| Rate for Payer: First Health Workers Compensation |
$140.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$327.51
|
| Rate for Payer: GEHA Commercial |
$254.73
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$327.51
|
| Rate for Payer: Multiplan All |
$331.15
|
| Rate for Payer: OMNI Networks Commercial |
$254.73
|
| Rate for Payer: One Health Plan PPO/POS |
$327.51
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$345.70
|
| Rate for Payer: Three Rivers Provider Network All |
$272.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$338.43
|
| Rate for Payer: Zelis Auto |
$145.56
|
| Rate for Payer: Zelis Worker's Compensation |
$99.34
|
|
|
OFF/OTHR OP CONS NEW/ESTAB; 55 MINS OR M
|
Facility
|
OP
|
$515.00
|
|
|
Service Code
|
CPT 99245
|
| Hospital Charge Code |
24700033
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$128.75 |
| Max. Negotiated Rate |
$489.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$309.00
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$437.75
|
| Rate for Payer: First Health Commercial |
$463.50
|
| Rate for Payer: First Health Workers Compensation |
$198.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$463.50
|
| Rate for Payer: GEHA Commercial |
$412.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$463.50
|
| Rate for Payer: Humana ChoiceCare |
$133.90
|
| Rate for Payer: Multiplan All |
$468.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$309.00
|
| Rate for Payer: OMNI Networks Commercial |
$360.50
|
| Rate for Payer: One Health Plan PPO/POS |
$463.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$489.25
|
| Rate for Payer: Three Rivers Provider Network All |
$386.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$453.20
|
| Rate for Payer: United Healthcare Commercial |
$437.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$128.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$478.95
|
| Rate for Payer: Zelis Auto |
$206.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$257.50
|
| Rate for Payer: Zelis Worker's Compensation |
$140.59
|
|
|
OFF/OTHR OP CONS NEW/ESTAB; 55 MINS OR M
|
Facility
|
IP
|
$515.00
|
|
|
Service Code
|
CPT 99245
|
| Hospital Charge Code |
24700033
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$140.59 |
| Max. Negotiated Rate |
$489.25 |
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$437.75
|
| Rate for Payer: First Health Commercial |
$463.50
|
| Rate for Payer: First Health Workers Compensation |
$198.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$463.50
|
| Rate for Payer: GEHA Commercial |
$360.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$463.50
|
| Rate for Payer: Multiplan All |
$468.65
|
| Rate for Payer: OMNI Networks Commercial |
$360.50
|
| Rate for Payer: One Health Plan PPO/POS |
$463.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$489.25
|
| Rate for Payer: Three Rivers Provider Network All |
$386.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$478.95
|
| Rate for Payer: Zelis Auto |
$206.00
|
| Rate for Payer: Zelis Worker's Compensation |
$140.59
|
|
|
OFF/OTHR OP CONS NEW/ESTAB; 55 MINS OR M
|
Facility
|
IP
|
$515.00
|
|
|
Service Code
|
CPT 99245
|
| Hospital Charge Code |
21599245
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$140.59 |
| Max. Negotiated Rate |
$489.25 |
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$437.75
|
| Rate for Payer: First Health Commercial |
$463.50
|
| Rate for Payer: First Health Workers Compensation |
$198.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$463.50
|
| Rate for Payer: GEHA Commercial |
$360.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$463.50
|
| Rate for Payer: Multiplan All |
$468.65
|
| Rate for Payer: OMNI Networks Commercial |
$360.50
|
| Rate for Payer: One Health Plan PPO/POS |
$463.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$489.25
|
| Rate for Payer: Three Rivers Provider Network All |
$386.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$478.95
|
| Rate for Payer: Zelis Auto |
$206.00
|
| Rate for Payer: Zelis Worker's Compensation |
$140.59
|
|
|
OFF/OTHR OP CONS NEW/ESTAB; 55 MINS OR M
|
Facility
|
OP
|
$515.00
|
|
|
Service Code
|
CPT 99245
|
| Hospital Charge Code |
24500033
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$128.75 |
| Max. Negotiated Rate |
$489.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$309.00
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$437.75
|
| Rate for Payer: First Health Commercial |
$463.50
|
| Rate for Payer: First Health Workers Compensation |
$198.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$463.50
|
| Rate for Payer: GEHA Commercial |
$412.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$463.50
|
| Rate for Payer: Humana ChoiceCare |
$133.90
|
| Rate for Payer: Multiplan All |
$468.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$309.00
|
| Rate for Payer: OMNI Networks Commercial |
$360.50
|
| Rate for Payer: One Health Plan PPO/POS |
$463.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$489.25
|
| Rate for Payer: Three Rivers Provider Network All |
$386.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$453.20
|
| Rate for Payer: United Healthcare Commercial |
$437.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$128.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$478.95
|
| Rate for Payer: Zelis Auto |
$206.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$257.50
|
| Rate for Payer: Zelis Worker's Compensation |
$140.59
|
|
|
OFF/OTHR OP CONS NEW/ESTAB; 55 MINS OR M
|
Facility
|
IP
|
$515.00
|
|
|
Service Code
|
CPT 99245
|
| Hospital Charge Code |
24500033
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$140.59 |
| Max. Negotiated Rate |
$489.25 |
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$437.75
|
| Rate for Payer: First Health Commercial |
$463.50
|
| Rate for Payer: First Health Workers Compensation |
$198.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$463.50
|
| Rate for Payer: GEHA Commercial |
$360.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$463.50
|
| Rate for Payer: Multiplan All |
$468.65
|
| Rate for Payer: OMNI Networks Commercial |
$360.50
|
| Rate for Payer: One Health Plan PPO/POS |
$463.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$489.25
|
| Rate for Payer: Three Rivers Provider Network All |
$386.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$478.95
|
| Rate for Payer: Zelis Auto |
$206.00
|
| Rate for Payer: Zelis Worker's Compensation |
$140.59
|
|
|
OFF/OTHR OP CONS NEW/ESTAB; 55 MINS OR M
|
Facility
|
IP
|
$515.00
|
|
|
Service Code
|
CPT 99245
|
| Hospital Charge Code |
7999245
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$140.59 |
| Max. Negotiated Rate |
$489.25 |
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$437.75
|
| Rate for Payer: First Health Commercial |
$463.50
|
| Rate for Payer: First Health Workers Compensation |
$198.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$463.50
|
| Rate for Payer: GEHA Commercial |
$360.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$463.50
|
| Rate for Payer: Multiplan All |
$468.65
|
| Rate for Payer: OMNI Networks Commercial |
$360.50
|
| Rate for Payer: One Health Plan PPO/POS |
$463.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$489.25
|
| Rate for Payer: Three Rivers Provider Network All |
$386.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$478.95
|
| Rate for Payer: Zelis Auto |
$206.00
|
| Rate for Payer: Zelis Worker's Compensation |
$140.59
|
|
|
OFF/OTHR OP CONS NEW/ESTAB; 55 MINS OR M
|
Facility
|
IP
|
$515.00
|
|
|
Service Code
|
CPT 99245
|
| Hospital Charge Code |
21600063
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$140.59 |
| Max. Negotiated Rate |
$489.25 |
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$437.75
|
| Rate for Payer: First Health Commercial |
$463.50
|
| Rate for Payer: First Health Workers Compensation |
$198.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$463.50
|
| Rate for Payer: GEHA Commercial |
$360.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$463.50
|
| Rate for Payer: Multiplan All |
$468.65
|
| Rate for Payer: OMNI Networks Commercial |
$360.50
|
| Rate for Payer: One Health Plan PPO/POS |
$463.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$489.25
|
| Rate for Payer: Three Rivers Provider Network All |
$386.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$478.95
|
| Rate for Payer: Zelis Auto |
$206.00
|
| Rate for Payer: Zelis Worker's Compensation |
$140.59
|
|
|
OFF/OTHR OP CONS NEW/ESTAB; 55 MINS OR M
|
Facility
|
IP
|
$515.00
|
|
|
Service Code
|
CPT 99245
|
| Hospital Charge Code |
23099245
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$140.59 |
| Max. Negotiated Rate |
$489.25 |
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$437.75
|
| Rate for Payer: First Health Commercial |
$463.50
|
| Rate for Payer: First Health Workers Compensation |
$198.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$463.50
|
| Rate for Payer: GEHA Commercial |
$360.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$463.50
|
| Rate for Payer: Multiplan All |
$468.65
|
| Rate for Payer: OMNI Networks Commercial |
$360.50
|
| Rate for Payer: One Health Plan PPO/POS |
$463.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$489.25
|
| Rate for Payer: Three Rivers Provider Network All |
$386.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$478.95
|
| Rate for Payer: Zelis Auto |
$206.00
|
| Rate for Payer: Zelis Worker's Compensation |
$140.59
|
|
|
OFF/OTHR OP CONS NEW/ESTAB; 55 MINS OR M
|
Facility
|
OP
|
$515.00
|
|
|
Service Code
|
CPT 99245
|
| Hospital Charge Code |
21099245
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$128.75 |
| Max. Negotiated Rate |
$489.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$309.00
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$437.75
|
| Rate for Payer: First Health Commercial |
$463.50
|
| Rate for Payer: First Health Workers Compensation |
$198.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$463.50
|
| Rate for Payer: GEHA Commercial |
$412.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$463.50
|
| Rate for Payer: Humana ChoiceCare |
$133.90
|
| Rate for Payer: Multiplan All |
$468.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$309.00
|
| Rate for Payer: OMNI Networks Commercial |
$360.50
|
| Rate for Payer: One Health Plan PPO/POS |
$463.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$489.25
|
| Rate for Payer: Three Rivers Provider Network All |
$386.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$453.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$128.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$478.95
|
| Rate for Payer: Zelis Auto |
$206.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$257.50
|
| Rate for Payer: Zelis Worker's Compensation |
$140.59
|
|
|
OFF/OTHR OP CONS NEW/ESTAB; 55 MINS OR M
|
Facility
|
OP
|
$515.00
|
|
|
Service Code
|
CPT 99245
|
| Hospital Charge Code |
23099245
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$128.75 |
| Max. Negotiated Rate |
$489.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$309.00
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$437.75
|
| Rate for Payer: First Health Commercial |
$463.50
|
| Rate for Payer: First Health Workers Compensation |
$198.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$463.50
|
| Rate for Payer: GEHA Commercial |
$412.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$463.50
|
| Rate for Payer: Humana ChoiceCare |
$133.90
|
| Rate for Payer: Multiplan All |
$468.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$309.00
|
| Rate for Payer: OMNI Networks Commercial |
$360.50
|
| Rate for Payer: One Health Plan PPO/POS |
$463.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$489.25
|
| Rate for Payer: Three Rivers Provider Network All |
$386.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$453.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$128.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$478.95
|
| Rate for Payer: Zelis Auto |
$206.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$257.50
|
| Rate for Payer: Zelis Worker's Compensation |
$140.59
|
|
|
OFF/OTHR OP CONS NEW/ESTAB; 55 MINS OR M
|
Facility
|
IP
|
$515.00
|
|
|
Service Code
|
CPT 99245
|
| Hospital Charge Code |
25500063
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$140.59 |
| Max. Negotiated Rate |
$489.25 |
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$437.75
|
| Rate for Payer: First Health Commercial |
$463.50
|
| Rate for Payer: First Health Workers Compensation |
$198.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$463.50
|
| Rate for Payer: GEHA Commercial |
$360.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$463.50
|
| Rate for Payer: Multiplan All |
$468.65
|
| Rate for Payer: OMNI Networks Commercial |
$360.50
|
| Rate for Payer: One Health Plan PPO/POS |
$463.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$489.25
|
| Rate for Payer: Three Rivers Provider Network All |
$386.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$478.95
|
| Rate for Payer: Zelis Auto |
$206.00
|
| Rate for Payer: Zelis Worker's Compensation |
$140.59
|
|
|
OFF/OTHR OP CONS NEW/ESTAB; 55 MINS OR M
|
Facility
|
OP
|
$363.90
|
|
|
Service Code
|
CPT 99245
|
| Hospital Charge Code |
8599245
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$90.97 |
| Max. Negotiated Rate |
$345.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$218.34
|
| Rate for Payer: Cash Price |
$218.34
|
| Rate for Payer: Cigna Commercial |
$309.31
|
| Rate for Payer: First Health Commercial |
$327.51
|
| Rate for Payer: First Health Workers Compensation |
$140.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$327.51
|
| Rate for Payer: GEHA Commercial |
$291.12
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$327.51
|
| Rate for Payer: Humana ChoiceCare |
$94.61
|
| Rate for Payer: Multiplan All |
$331.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$218.34
|
| Rate for Payer: OMNI Networks Commercial |
$254.73
|
| Rate for Payer: One Health Plan PPO/POS |
$327.51
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$345.70
|
| Rate for Payer: Three Rivers Provider Network All |
$272.93
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$320.23
|
| Rate for Payer: United Healthcare Managed Medicaid |
$90.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$338.43
|
| Rate for Payer: Zelis Auto |
$145.56
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$181.95
|
| Rate for Payer: Zelis Worker's Compensation |
$99.34
|
|
|
OFF/OTHR OP CONS NEW/ESTAB; 55 MINS OR M
|
Facility
|
OP
|
$515.00
|
|
|
Service Code
|
CPT 99245
|
| Hospital Charge Code |
21999245
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$128.75 |
| Max. Negotiated Rate |
$489.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$309.00
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$437.75
|
| Rate for Payer: First Health Commercial |
$463.50
|
| Rate for Payer: First Health Workers Compensation |
$198.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$463.50
|
| Rate for Payer: GEHA Commercial |
$412.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$463.50
|
| Rate for Payer: Humana ChoiceCare |
$133.90
|
| Rate for Payer: Multiplan All |
$468.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$309.00
|
| Rate for Payer: OMNI Networks Commercial |
$360.50
|
| Rate for Payer: One Health Plan PPO/POS |
$463.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$489.25
|
| Rate for Payer: Three Rivers Provider Network All |
$386.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$453.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$128.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$478.95
|
| Rate for Payer: Zelis Auto |
$206.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$257.50
|
| Rate for Payer: Zelis Worker's Compensation |
$140.59
|
|
|
OFF/OTHR OP CONS NEW/ESTAB; 55 MINS OR M
|
Facility
|
OP
|
$515.00
|
|
|
Service Code
|
CPT 99245
|
| Hospital Charge Code |
25500063
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$128.75 |
| Max. Negotiated Rate |
$489.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$309.00
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$437.75
|
| Rate for Payer: First Health Commercial |
$463.50
|
| Rate for Payer: First Health Workers Compensation |
$198.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$463.50
|
| Rate for Payer: GEHA Commercial |
$412.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$463.50
|
| Rate for Payer: Humana ChoiceCare |
$133.90
|
| Rate for Payer: Multiplan All |
$468.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$309.00
|
| Rate for Payer: OMNI Networks Commercial |
$360.50
|
| Rate for Payer: One Health Plan PPO/POS |
$463.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$489.25
|
| Rate for Payer: Three Rivers Provider Network All |
$386.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$453.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$128.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$478.95
|
| Rate for Payer: Zelis Auto |
$206.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$257.50
|
| Rate for Payer: Zelis Worker's Compensation |
$140.59
|
|
|
OFF/OTHR OP CONS NEW/ESTAB; 55 MINS OR M
|
Facility
|
IP
|
$515.00
|
|
|
Service Code
|
CPT 99245
|
| Hospital Charge Code |
21099245
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$140.59 |
| Max. Negotiated Rate |
$489.25 |
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$437.75
|
| Rate for Payer: First Health Commercial |
$463.50
|
| Rate for Payer: First Health Workers Compensation |
$198.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$463.50
|
| Rate for Payer: GEHA Commercial |
$360.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$463.50
|
| Rate for Payer: Multiplan All |
$468.65
|
| Rate for Payer: OMNI Networks Commercial |
$360.50
|
| Rate for Payer: One Health Plan PPO/POS |
$463.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$489.25
|
| Rate for Payer: Three Rivers Provider Network All |
$386.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$478.95
|
| Rate for Payer: Zelis Auto |
$206.00
|
| Rate for Payer: Zelis Worker's Compensation |
$140.59
|
|
|
OFF/OTHR OP CONS NEW/ESTAB; 55 MINS OR M
|
Facility
|
OP
|
$515.00
|
|
|
Service Code
|
CPT 99245
|
| Hospital Charge Code |
21799245
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$128.75 |
| Max. Negotiated Rate |
$489.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$309.00
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$437.75
|
| Rate for Payer: First Health Commercial |
$463.50
|
| Rate for Payer: First Health Workers Compensation |
$198.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$463.50
|
| Rate for Payer: GEHA Commercial |
$412.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$463.50
|
| Rate for Payer: Humana ChoiceCare |
$133.90
|
| Rate for Payer: Multiplan All |
$468.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$309.00
|
| Rate for Payer: OMNI Networks Commercial |
$360.50
|
| Rate for Payer: One Health Plan PPO/POS |
$463.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$489.25
|
| Rate for Payer: Three Rivers Provider Network All |
$386.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$453.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$128.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$478.95
|
| Rate for Payer: Zelis Auto |
$206.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$257.50
|
| Rate for Payer: Zelis Worker's Compensation |
$140.59
|
|
|
OFF/OTHR OP CONS NEW/ESTAB; 55 MINS OR M
|
Facility
|
IP
|
$515.00
|
|
|
Service Code
|
CPT 99245
|
| Hospital Charge Code |
8699245
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$140.59 |
| Max. Negotiated Rate |
$489.25 |
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$437.75
|
| Rate for Payer: First Health Commercial |
$463.50
|
| Rate for Payer: First Health Workers Compensation |
$198.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$463.50
|
| Rate for Payer: GEHA Commercial |
$360.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$463.50
|
| Rate for Payer: Multiplan All |
$468.65
|
| Rate for Payer: OMNI Networks Commercial |
$360.50
|
| Rate for Payer: One Health Plan PPO/POS |
$463.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$489.25
|
| Rate for Payer: Three Rivers Provider Network All |
$386.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$478.95
|
| Rate for Payer: Zelis Auto |
$206.00
|
| Rate for Payer: Zelis Worker's Compensation |
$140.59
|
|
|
OFF/OTHR OP CONS NEW/ESTAB; 55 MINS OR M
|
Facility
|
OP
|
$515.00
|
|
|
Service Code
|
CPT 99245
|
| Hospital Charge Code |
7999245
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$128.75 |
| Max. Negotiated Rate |
$489.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$309.00
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$437.75
|
| Rate for Payer: First Health Commercial |
$463.50
|
| Rate for Payer: First Health Workers Compensation |
$198.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$463.50
|
| Rate for Payer: GEHA Commercial |
$412.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$463.50
|
| Rate for Payer: Humana ChoiceCare |
$133.90
|
| Rate for Payer: Multiplan All |
$468.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$309.00
|
| Rate for Payer: OMNI Networks Commercial |
$360.50
|
| Rate for Payer: One Health Plan PPO/POS |
$463.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$489.25
|
| Rate for Payer: Three Rivers Provider Network All |
$386.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$453.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$128.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$478.95
|
| Rate for Payer: Zelis Auto |
$206.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$257.50
|
| Rate for Payer: Zelis Worker's Compensation |
$140.59
|
|
|
OFF/OTHR OP CONS NEW/ESTAB; 55 MINS OR M
|
Facility
|
IP
|
$515.00
|
|
|
Service Code
|
CPT 99245
|
| Hospital Charge Code |
21999245
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$140.59 |
| Max. Negotiated Rate |
$489.25 |
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$437.75
|
| Rate for Payer: First Health Commercial |
$463.50
|
| Rate for Payer: First Health Workers Compensation |
$198.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$463.50
|
| Rate for Payer: GEHA Commercial |
$360.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$463.50
|
| Rate for Payer: Multiplan All |
$468.65
|
| Rate for Payer: OMNI Networks Commercial |
$360.50
|
| Rate for Payer: One Health Plan PPO/POS |
$463.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$489.25
|
| Rate for Payer: Three Rivers Provider Network All |
$386.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$478.95
|
| Rate for Payer: Zelis Auto |
$206.00
|
| Rate for Payer: Zelis Worker's Compensation |
$140.59
|
|
|
OFF/OTHR OP CONS NEW/ESTAB; 55 MINS OR M
|
Facility
|
IP
|
$363.90
|
|
|
Service Code
|
CPT 99245
|
| Hospital Charge Code |
7299245
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$99.34 |
| Max. Negotiated Rate |
$345.70 |
| Rate for Payer: Cash Price |
$218.34
|
| Rate for Payer: Cigna Commercial |
$309.31
|
| Rate for Payer: First Health Commercial |
$327.51
|
| Rate for Payer: First Health Workers Compensation |
$140.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$327.51
|
| Rate for Payer: GEHA Commercial |
$254.73
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$327.51
|
| Rate for Payer: Multiplan All |
$331.15
|
| Rate for Payer: OMNI Networks Commercial |
$254.73
|
| Rate for Payer: One Health Plan PPO/POS |
$327.51
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$345.70
|
| Rate for Payer: Three Rivers Provider Network All |
$272.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$338.43
|
| Rate for Payer: Zelis Auto |
$145.56
|
| Rate for Payer: Zelis Worker's Compensation |
$99.34
|
|
