|
93297 REM INTERROG <30 ICPMS D
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 93297
|
| Hospital Charge Code |
8693297
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$79.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$50.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$36.13
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$71.40
|
| Rate for Payer: First Health Commercial |
$75.60
|
| Rate for Payer: First Health Workers Compensation |
$32.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$75.60
|
| Rate for Payer: GEHA Commercial |
$67.20
|
| Rate for Payer: GEHA Medicare |
$36.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$75.60
|
| Rate for Payer: Humana ChoiceCare |
$39.74
|
| Rate for Payer: Humana Medicare Advantage |
$36.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$60.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$36.13
|
| Rate for Payer: Multiplan All |
$76.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$61.42
|
| Rate for Payer: OMNI Networks Commercial |
$58.80
|
| Rate for Payer: One Health Plan PPO/POS |
$75.60
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$36.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$79.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$72.26
|
| Rate for Payer: Three Rivers Provider Network All |
$63.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$35.41
|
| Rate for Payer: United Healthcare Managed Medicaid |
$21.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$78.12
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$36.13
|
| Rate for Payer: Zelis Auto |
$33.60
|
| Rate for Payer: Zelis Medicare |
$30.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$43.36
|
| Rate for Payer: Zelis Worker's Compensation |
$22.93
|
|
|
93297 REM INTERROG <30 ICPMS D
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT 93297
|
| Hospital Charge Code |
8693297
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$22.93 |
| Max. Negotiated Rate |
$79.80 |
| Rate for Payer: One Health Plan PPO/POS |
$75.60
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$71.40
|
| Rate for Payer: First Health Commercial |
$75.60
|
| Rate for Payer: First Health Workers Compensation |
$32.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$75.60
|
| Rate for Payer: GEHA Commercial |
$58.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$75.60
|
| Rate for Payer: Multiplan All |
$76.44
|
| Rate for Payer: OMNI Networks Commercial |
$58.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$79.80
|
| Rate for Payer: Three Rivers Provider Network All |
$63.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$78.12
|
| Rate for Payer: Zelis Auto |
$33.60
|
| Rate for Payer: Zelis Worker's Compensation |
$22.93
|
|
|
93298 REM INTERROG < 30 SCRMS D
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
CPT 93298
|
| Hospital Charge Code |
8699253
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$76.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$48.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$36.13
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$68.85
|
| Rate for Payer: First Health Commercial |
$72.90
|
| Rate for Payer: First Health Workers Compensation |
$31.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$72.90
|
| Rate for Payer: GEHA Commercial |
$64.80
|
| Rate for Payer: GEHA Medicare |
$36.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$72.90
|
| Rate for Payer: Humana ChoiceCare |
$39.74
|
| Rate for Payer: Humana Medicare Advantage |
$36.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$60.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$36.13
|
| Rate for Payer: Multiplan All |
$73.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$61.42
|
| Rate for Payer: OMNI Networks Commercial |
$56.70
|
| Rate for Payer: One Health Plan PPO/POS |
$72.90
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$36.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$76.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$72.26
|
| Rate for Payer: Three Rivers Provider Network All |
$60.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$35.41
|
| Rate for Payer: United Healthcare Managed Medicaid |
$20.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$75.33
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$36.13
|
| Rate for Payer: Zelis Auto |
$32.40
|
| Rate for Payer: Zelis Medicare |
$30.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$43.36
|
| Rate for Payer: Zelis Worker's Compensation |
$22.11
|
|
|
93298 REM INTERROG < 30 SCRMS D
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
CPT 93298
|
| Hospital Charge Code |
8699253
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$76.95 |
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$68.85
|
| Rate for Payer: First Health Commercial |
$72.90
|
| Rate for Payer: First Health Workers Compensation |
$31.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$72.90
|
| Rate for Payer: GEHA Commercial |
$56.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$72.90
|
| Rate for Payer: Multiplan All |
$73.71
|
| Rate for Payer: OMNI Networks Commercial |
$56.70
|
| Rate for Payer: One Health Plan PPO/POS |
$72.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$76.95
|
| Rate for Payer: Three Rivers Provider Network All |
$60.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$75.33
|
| Rate for Payer: Zelis Auto |
$32.40
|
| Rate for Payer: Zelis Worker's Compensation |
$22.11
|
|
|
93880 DUPLEX SCAN EXTCRANIAL ART COMP
|
Facility
|
IP
|
$587.00
|
|
|
Service Code
|
CPT 93880
|
| Hospital Charge Code |
21900113
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$160.25 |
| Max. Negotiated Rate |
$557.65 |
| Rate for Payer: Cash Price |
$352.20
|
| Rate for Payer: Cigna Commercial |
$498.95
|
| Rate for Payer: First Health Commercial |
$528.30
|
| Rate for Payer: First Health Workers Compensation |
$226.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$528.30
|
| Rate for Payer: GEHA Commercial |
$410.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$528.30
|
| Rate for Payer: Multiplan All |
$534.17
|
| Rate for Payer: OMNI Networks Commercial |
$410.90
|
| Rate for Payer: One Health Plan PPO/POS |
$528.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$557.65
|
| Rate for Payer: Three Rivers Provider Network All |
$440.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$545.91
|
| Rate for Payer: Zelis Auto |
$234.80
|
| Rate for Payer: Zelis Worker's Compensation |
$160.25
|
|
|
93880 DUPLEX SCAN EXTCRANIAL ART COMP
|
Facility
|
OP
|
$587.00
|
|
|
Service Code
|
CPT 93880
|
| Hospital Charge Code |
21700004
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$160.25 |
| Max. Negotiated Rate |
$557.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$232.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$352.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$232.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$184.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$234.22
|
| Rate for Payer: Cash Price |
$352.20
|
| Rate for Payer: Cash Price |
$352.20
|
| Rate for Payer: Cigna Commercial |
$498.95
|
| Rate for Payer: First Health Commercial |
$528.30
|
| Rate for Payer: First Health Workers Compensation |
$226.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$528.30
|
| Rate for Payer: GEHA Commercial |
$469.60
|
| Rate for Payer: GEHA Medicare |
$234.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$528.30
|
| Rate for Payer: Humana ChoiceCare |
$257.64
|
| Rate for Payer: Humana Medicare Advantage |
$234.22
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$393.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$188.02
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$234.22
|
| Rate for Payer: Multiplan All |
$534.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$398.17
|
| Rate for Payer: OMNI Networks Commercial |
$410.90
|
| Rate for Payer: One Health Plan PPO/POS |
$528.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$217.10
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$188.02
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$234.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$557.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$468.44
|
| Rate for Payer: Three Rivers Provider Network All |
$440.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$229.54
|
| Rate for Payer: United Healthcare Managed Medicaid |
$188.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$234.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$545.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$234.22
|
| Rate for Payer: Zelis Auto |
$234.80
|
| Rate for Payer: Zelis Medicare |
$199.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$281.06
|
| Rate for Payer: Zelis Worker's Compensation |
$160.25
|
|
|
93880 DUPLEX SCAN EXTCRANIAL ART COMP
|
Facility
|
IP
|
$587.00
|
|
|
Service Code
|
CPT 93880
|
| Hospital Charge Code |
21700004
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$160.25 |
| Max. Negotiated Rate |
$557.65 |
| Rate for Payer: Cash Price |
$352.20
|
| Rate for Payer: Cigna Commercial |
$498.95
|
| Rate for Payer: First Health Commercial |
$528.30
|
| Rate for Payer: First Health Workers Compensation |
$226.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$528.30
|
| Rate for Payer: GEHA Commercial |
$410.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$528.30
|
| Rate for Payer: Multiplan All |
$534.17
|
| Rate for Payer: OMNI Networks Commercial |
$410.90
|
| Rate for Payer: One Health Plan PPO/POS |
$528.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$557.65
|
| Rate for Payer: Three Rivers Provider Network All |
$440.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$545.91
|
| Rate for Payer: Zelis Auto |
$234.80
|
| Rate for Payer: Zelis Worker's Compensation |
$160.25
|
|
|
93880 DUPLEX SCAN EXTCRANIAL ART COMP
|
Facility
|
OP
|
$587.00
|
|
|
Service Code
|
CPT 93880
|
| Hospital Charge Code |
21900113
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$160.25 |
| Max. Negotiated Rate |
$557.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$232.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$352.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$232.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$184.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$234.22
|
| Rate for Payer: Cash Price |
$352.20
|
| Rate for Payer: Cash Price |
$352.20
|
| Rate for Payer: Cigna Commercial |
$498.95
|
| Rate for Payer: First Health Commercial |
$528.30
|
| Rate for Payer: First Health Workers Compensation |
$226.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$528.30
|
| Rate for Payer: GEHA Commercial |
$469.60
|
| Rate for Payer: GEHA Medicare |
$234.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$528.30
|
| Rate for Payer: Humana ChoiceCare |
$257.64
|
| Rate for Payer: Humana Medicare Advantage |
$234.22
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$393.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$188.02
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$234.22
|
| Rate for Payer: Multiplan All |
$534.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$398.17
|
| Rate for Payer: OMNI Networks Commercial |
$410.90
|
| Rate for Payer: One Health Plan PPO/POS |
$528.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$217.10
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$188.02
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$234.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$557.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$468.44
|
| Rate for Payer: Three Rivers Provider Network All |
$440.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$229.54
|
| Rate for Payer: United Healthcare Managed Medicaid |
$188.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$234.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$545.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$234.22
|
| Rate for Payer: Zelis Auto |
$234.80
|
| Rate for Payer: Zelis Medicare |
$199.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$281.06
|
| Rate for Payer: Zelis Worker's Compensation |
$160.25
|
|
|
93886 INTRACRANIAL COMPLETE STUDY
|
Facility
|
OP
|
$797.00
|
|
|
Service Code
|
CPT 93886
|
| Hospital Charge Code |
21900114
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$184.27 |
| Max. Negotiated Rate |
$757.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$232.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$478.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$232.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$184.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$234.22
|
| Rate for Payer: Cash Price |
$478.20
|
| Rate for Payer: Cash Price |
$478.20
|
| Rate for Payer: Cigna Commercial |
$677.45
|
| Rate for Payer: First Health Commercial |
$717.30
|
| Rate for Payer: First Health Workers Compensation |
$307.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$717.30
|
| Rate for Payer: GEHA Commercial |
$637.60
|
| Rate for Payer: GEHA Medicare |
$234.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$717.30
|
| Rate for Payer: Humana ChoiceCare |
$257.64
|
| Rate for Payer: Humana Medicare Advantage |
$234.22
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$393.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$188.02
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$234.22
|
| Rate for Payer: Multiplan All |
$725.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$398.17
|
| Rate for Payer: OMNI Networks Commercial |
$557.90
|
| Rate for Payer: One Health Plan PPO/POS |
$717.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$217.10
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$188.02
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$234.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$757.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$468.44
|
| Rate for Payer: Three Rivers Provider Network All |
$597.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$229.54
|
| Rate for Payer: United Healthcare Managed Medicaid |
$188.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$234.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$741.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$234.22
|
| Rate for Payer: Zelis Auto |
$318.80
|
| Rate for Payer: Zelis Medicare |
$199.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$281.06
|
| Rate for Payer: Zelis Worker's Compensation |
$217.58
|
|
|
93886 INTRACRANIAL COMPLETE STUDY
|
Facility
|
OP
|
$797.00
|
|
|
Service Code
|
CPT 93886
|
| Hospital Charge Code |
21700005
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$184.27 |
| Max. Negotiated Rate |
$757.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$232.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$478.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$232.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$184.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$234.22
|
| Rate for Payer: Cash Price |
$478.20
|
| Rate for Payer: Cash Price |
$478.20
|
| Rate for Payer: Cigna Commercial |
$677.45
|
| Rate for Payer: First Health Commercial |
$717.30
|
| Rate for Payer: First Health Workers Compensation |
$307.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$717.30
|
| Rate for Payer: GEHA Commercial |
$637.60
|
| Rate for Payer: GEHA Medicare |
$234.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$717.30
|
| Rate for Payer: Humana ChoiceCare |
$257.64
|
| Rate for Payer: Humana Medicare Advantage |
$234.22
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$393.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$188.02
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$234.22
|
| Rate for Payer: Multiplan All |
$725.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$398.17
|
| Rate for Payer: OMNI Networks Commercial |
$557.90
|
| Rate for Payer: One Health Plan PPO/POS |
$717.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$217.10
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$188.02
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$234.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$757.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$468.44
|
| Rate for Payer: Three Rivers Provider Network All |
$597.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$229.54
|
| Rate for Payer: United Healthcare Managed Medicaid |
$188.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$234.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$741.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$234.22
|
| Rate for Payer: Zelis Auto |
$318.80
|
| Rate for Payer: Zelis Medicare |
$199.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$281.06
|
| Rate for Payer: Zelis Worker's Compensation |
$217.58
|
|
|
93886 INTRACRANIAL COMPLETE STUDY
|
Facility
|
IP
|
$797.00
|
|
|
Service Code
|
CPT 93886
|
| Hospital Charge Code |
21900114
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$217.58 |
| Max. Negotiated Rate |
$757.15 |
| Rate for Payer: Cash Price |
$478.20
|
| Rate for Payer: Cigna Commercial |
$677.45
|
| Rate for Payer: First Health Commercial |
$717.30
|
| Rate for Payer: First Health Workers Compensation |
$307.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$717.30
|
| Rate for Payer: GEHA Commercial |
$557.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$717.30
|
| Rate for Payer: Multiplan All |
$725.27
|
| Rate for Payer: OMNI Networks Commercial |
$557.90
|
| Rate for Payer: One Health Plan PPO/POS |
$717.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$757.15
|
| Rate for Payer: Three Rivers Provider Network All |
$597.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$741.21
|
| Rate for Payer: Zelis Auto |
$318.80
|
| Rate for Payer: Zelis Worker's Compensation |
$217.58
|
|
|
93886 INTRACRANIAL COMPLETE STUDY
|
Facility
|
IP
|
$797.00
|
|
|
Service Code
|
CPT 93886
|
| Hospital Charge Code |
21700005
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$217.58 |
| Max. Negotiated Rate |
$757.15 |
| Rate for Payer: Cash Price |
$478.20
|
| Rate for Payer: Cigna Commercial |
$677.45
|
| Rate for Payer: First Health Commercial |
$717.30
|
| Rate for Payer: First Health Workers Compensation |
$307.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$717.30
|
| Rate for Payer: GEHA Commercial |
$557.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$717.30
|
| Rate for Payer: Multiplan All |
$725.27
|
| Rate for Payer: OMNI Networks Commercial |
$557.90
|
| Rate for Payer: One Health Plan PPO/POS |
$717.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$757.15
|
| Rate for Payer: Three Rivers Provider Network All |
$597.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$741.21
|
| Rate for Payer: Zelis Auto |
$318.80
|
| Rate for Payer: Zelis Worker's Compensation |
$217.58
|
|
|
95249 CONT GLUC MONITORING PT PROV EQUIP
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT 95249
|
| Hospital Charge Code |
21095249
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.93 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$83.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$149.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$83.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$66.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$57.56
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$224.10
|
| Rate for Payer: First Health Workers Compensation |
$96.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$224.10
|
| Rate for Payer: GEHA Commercial |
$199.20
|
| Rate for Payer: GEHA Medicare |
$57.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| Rate for Payer: Humana ChoiceCare |
$63.32
|
| Rate for Payer: Humana Medicare Advantage |
$57.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$96.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$67.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$57.56
|
| Rate for Payer: Multiplan All |
$226.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$97.85
|
| Rate for Payer: OMNI Networks Commercial |
$174.30
|
| Rate for Payer: One Health Plan PPO/POS |
$224.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$78.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$67.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$57.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$236.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$115.12
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$56.41
|
| Rate for Payer: United Healthcare Managed Medicaid |
$67.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$57.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$231.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$57.56
|
| Rate for Payer: Zelis Auto |
$99.60
|
| Rate for Payer: Zelis Medicare |
$48.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$69.07
|
| Rate for Payer: Zelis Worker's Compensation |
$67.98
|
|
|
95249 CONT GLUC MONITORING PT PROV EQUIP
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT 95249
|
| Hospital Charge Code |
20595249
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$67.98 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$224.10
|
| Rate for Payer: First Health Workers Compensation |
$96.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$224.10
|
| Rate for Payer: GEHA Commercial |
$174.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| Rate for Payer: Multiplan All |
$226.59
|
| Rate for Payer: OMNI Networks Commercial |
$174.30
|
| Rate for Payer: One Health Plan PPO/POS |
$224.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$236.55
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$231.57
|
| Rate for Payer: Zelis Auto |
$99.60
|
| Rate for Payer: Zelis Worker's Compensation |
$67.98
|
|
|
95249 CONT GLUC MONITORING PT PROV EQUIP
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT 95249
|
| Hospital Charge Code |
21095249
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$67.98 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$224.10
|
| Rate for Payer: First Health Workers Compensation |
$96.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$224.10
|
| Rate for Payer: GEHA Commercial |
$174.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| Rate for Payer: Multiplan All |
$226.59
|
| Rate for Payer: OMNI Networks Commercial |
$174.30
|
| Rate for Payer: One Health Plan PPO/POS |
$224.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$236.55
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$231.57
|
| Rate for Payer: Zelis Auto |
$99.60
|
| Rate for Payer: Zelis Worker's Compensation |
$67.98
|
|
|
95249 CONT GLUC MONITORING PT PROV EQUIP
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT 95249
|
| Hospital Charge Code |
20595249
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.93 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$83.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$149.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$83.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$66.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$57.56
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$224.10
|
| Rate for Payer: First Health Workers Compensation |
$96.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$224.10
|
| Rate for Payer: GEHA Commercial |
$199.20
|
| Rate for Payer: GEHA Medicare |
$57.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| Rate for Payer: Humana ChoiceCare |
$63.32
|
| Rate for Payer: Humana Medicare Advantage |
$57.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$96.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$67.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$57.56
|
| Rate for Payer: Multiplan All |
$226.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$97.85
|
| Rate for Payer: OMNI Networks Commercial |
$174.30
|
| Rate for Payer: One Health Plan PPO/POS |
$224.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$78.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$67.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$57.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$236.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$115.12
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$56.41
|
| Rate for Payer: United Healthcare Managed Medicaid |
$67.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$57.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$231.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$57.56
|
| Rate for Payer: Zelis Auto |
$99.60
|
| Rate for Payer: Zelis Medicare |
$48.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$69.07
|
| Rate for Payer: Zelis Worker's Compensation |
$67.98
|
|
|
95250 CONT GLUC MONITORING PHYS/QHP EQP
|
Facility
|
OP
|
$508.00
|
|
|
Service Code
|
CPT 95250
|
| Hospital Charge Code |
20595250
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$106.14 |
| Max. Negotiated Rate |
$482.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$304.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$134.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$124.87
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$431.80
|
| Rate for Payer: First Health Commercial |
$457.20
|
| Rate for Payer: First Health Workers Compensation |
$196.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$457.20
|
| Rate for Payer: GEHA Commercial |
$406.40
|
| Rate for Payer: GEHA Medicare |
$124.87
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$457.20
|
| Rate for Payer: Humana ChoiceCare |
$137.36
|
| Rate for Payer: Humana Medicare Advantage |
$124.87
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$209.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$137.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$124.87
|
| Rate for Payer: Multiplan All |
$462.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$212.28
|
| Rate for Payer: OMNI Networks Commercial |
$355.60
|
| Rate for Payer: One Health Plan PPO/POS |
$457.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$158.82
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$137.55
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$124.87
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$482.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$249.74
|
| Rate for Payer: Three Rivers Provider Network All |
$381.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$122.37
|
| Rate for Payer: United Healthcare Managed Medicaid |
$137.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$124.87
|
| Rate for Payer: United Payors & United Providers UP&UP |
$472.44
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$124.87
|
| Rate for Payer: Zelis Auto |
$203.20
|
| Rate for Payer: Zelis Medicare |
$106.14
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$149.84
|
| Rate for Payer: Zelis Worker's Compensation |
$138.68
|
|
|
95250 CONT GLUC MONITORING PHYS/QHP EQP
|
Facility
|
IP
|
$508.00
|
|
|
Service Code
|
CPT 95250
|
| Hospital Charge Code |
20595250
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$138.68 |
| Max. Negotiated Rate |
$482.60 |
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$431.80
|
| Rate for Payer: First Health Commercial |
$457.20
|
| Rate for Payer: First Health Workers Compensation |
$196.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$457.20
|
| Rate for Payer: GEHA Commercial |
$355.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$457.20
|
| Rate for Payer: Multiplan All |
$462.28
|
| Rate for Payer: OMNI Networks Commercial |
$355.60
|
| Rate for Payer: One Health Plan PPO/POS |
$457.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$482.60
|
| Rate for Payer: Three Rivers Provider Network All |
$381.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$472.44
|
| Rate for Payer: Zelis Auto |
$203.20
|
| Rate for Payer: Zelis Worker's Compensation |
$138.68
|
|
|
95250 GLUC MNTR CONT REC FROM INTERS TIS
|
Facility
|
IP
|
$452.00
|
|
|
Service Code
|
CPT 95250
|
| Hospital Charge Code |
21095250
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$123.40 |
| Max. Negotiated Rate |
$429.40 |
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cigna Commercial |
$384.20
|
| Rate for Payer: First Health Commercial |
$406.80
|
| Rate for Payer: First Health Workers Compensation |
$174.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$406.80
|
| Rate for Payer: GEHA Commercial |
$316.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$406.80
|
| Rate for Payer: Multiplan All |
$411.32
|
| Rate for Payer: OMNI Networks Commercial |
$316.40
|
| Rate for Payer: One Health Plan PPO/POS |
$406.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$429.40
|
| Rate for Payer: Three Rivers Provider Network All |
$339.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$420.36
|
| Rate for Payer: Zelis Auto |
$180.80
|
| Rate for Payer: Zelis Worker's Compensation |
$123.40
|
|
|
95250 GLUC MNTR CONT REC FROM INTERS TIS
|
Facility
|
OP
|
$452.00
|
|
|
Service Code
|
CPT 95250
|
| Hospital Charge Code |
21095250
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$106.14 |
| Max. Negotiated Rate |
$429.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$271.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$134.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$124.87
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cigna Commercial |
$384.20
|
| Rate for Payer: First Health Commercial |
$406.80
|
| Rate for Payer: First Health Workers Compensation |
$174.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$406.80
|
| Rate for Payer: GEHA Commercial |
$361.60
|
| Rate for Payer: GEHA Medicare |
$124.87
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$406.80
|
| Rate for Payer: Humana ChoiceCare |
$137.36
|
| Rate for Payer: Humana Medicare Advantage |
$124.87
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$209.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$137.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$124.87
|
| Rate for Payer: Multiplan All |
$411.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$212.28
|
| Rate for Payer: OMNI Networks Commercial |
$316.40
|
| Rate for Payer: One Health Plan PPO/POS |
$406.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$158.82
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$137.55
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$124.87
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$429.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$249.74
|
| Rate for Payer: Three Rivers Provider Network All |
$339.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$122.37
|
| Rate for Payer: United Healthcare Managed Medicaid |
$137.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$124.87
|
| Rate for Payer: United Payors & United Providers UP&UP |
$420.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$124.87
|
| Rate for Payer: Zelis Auto |
$180.80
|
| Rate for Payer: Zelis Medicare |
$106.14
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$149.84
|
| Rate for Payer: Zelis Worker's Compensation |
$123.40
|
|
|
95251 CONT CLUC MONITORING ANALYSIS I&R
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT 95251
|
| Hospital Charge Code |
20595251
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$37.40 |
| Max. Negotiated Rate |
$130.15 |
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$116.45
|
| Rate for Payer: First Health Commercial |
$123.30
|
| Rate for Payer: First Health Workers Compensation |
$52.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$123.30
|
| Rate for Payer: GEHA Commercial |
$95.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$123.30
|
| Rate for Payer: Multiplan All |
$124.67
|
| Rate for Payer: OMNI Networks Commercial |
$95.90
|
| Rate for Payer: One Health Plan PPO/POS |
$123.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$130.15
|
| Rate for Payer: Three Rivers Provider Network All |
$102.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$127.41
|
| Rate for Payer: Zelis Auto |
$54.80
|
| Rate for Payer: Zelis Worker's Compensation |
$37.40
|
|
|
95251 CONT CLUC MONITORING ANALYSIS I&R
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT 95251
|
| Hospital Charge Code |
20595251
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.25 |
| Max. Negotiated Rate |
$130.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$82.20
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$116.45
|
| Rate for Payer: First Health Commercial |
$123.30
|
| Rate for Payer: First Health Workers Compensation |
$52.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$123.30
|
| Rate for Payer: GEHA Commercial |
$109.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$123.30
|
| Rate for Payer: Humana ChoiceCare |
$35.62
|
| Rate for Payer: Multiplan All |
$124.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$82.20
|
| Rate for Payer: OMNI Networks Commercial |
$95.90
|
| Rate for Payer: One Health Plan PPO/POS |
$123.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$130.15
|
| Rate for Payer: Three Rivers Provider Network All |
$102.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$120.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$34.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$127.41
|
| Rate for Payer: Zelis Auto |
$54.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$68.50
|
| Rate for Payer: Zelis Worker's Compensation |
$37.40
|
|
|
95251 GLUC MNTR CONT REC NTRSTL TISS FLU
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT 95251
|
| Hospital Charge Code |
21095251
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$37.40 |
| Max. Negotiated Rate |
$130.15 |
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$116.45
|
| Rate for Payer: First Health Commercial |
$123.30
|
| Rate for Payer: First Health Workers Compensation |
$52.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$123.30
|
| Rate for Payer: GEHA Commercial |
$95.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$123.30
|
| Rate for Payer: Multiplan All |
$124.67
|
| Rate for Payer: OMNI Networks Commercial |
$95.90
|
| Rate for Payer: One Health Plan PPO/POS |
$123.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$130.15
|
| Rate for Payer: Three Rivers Provider Network All |
$102.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$127.41
|
| Rate for Payer: Zelis Auto |
$54.80
|
| Rate for Payer: Zelis Worker's Compensation |
$37.40
|
|
|
95251 GLUC MNTR CONT REC NTRSTL TISS FLU
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT 95251
|
| Hospital Charge Code |
21095251
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.25 |
| Max. Negotiated Rate |
$130.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$82.20
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$116.45
|
| Rate for Payer: First Health Commercial |
$123.30
|
| Rate for Payer: First Health Workers Compensation |
$52.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$123.30
|
| Rate for Payer: GEHA Commercial |
$109.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$123.30
|
| Rate for Payer: Humana ChoiceCare |
$35.62
|
| Rate for Payer: Multiplan All |
$124.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$82.20
|
| Rate for Payer: OMNI Networks Commercial |
$95.90
|
| Rate for Payer: One Health Plan PPO/POS |
$123.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$130.15
|
| Rate for Payer: Three Rivers Provider Network All |
$102.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$120.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$34.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$127.41
|
| Rate for Payer: Zelis Auto |
$54.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$68.50
|
| Rate for Payer: Zelis Worker's Compensation |
$37.40
|
|
|
95812 EEG 41-60 MINUTES
|
Facility
|
OP
|
$932.00
|
|
|
Service Code
|
CPT 95812
|
| Hospital Charge Code |
21700006
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$192.58 |
| Max. Negotiated Rate |
$885.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$243.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$559.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$243.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$192.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$301.74
|
| Rate for Payer: Cash Price |
$559.20
|
| Rate for Payer: Cash Price |
$559.20
|
| Rate for Payer: Cigna Commercial |
$792.20
|
| Rate for Payer: First Health Commercial |
$838.80
|
| Rate for Payer: First Health Workers Compensation |
$359.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$838.80
|
| Rate for Payer: GEHA Commercial |
$745.60
|
| Rate for Payer: GEHA Medicare |
$301.74
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$838.80
|
| Rate for Payer: Humana ChoiceCare |
$331.91
|
| Rate for Payer: Humana Medicare Advantage |
$301.74
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$506.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$196.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$301.74
|
| Rate for Payer: Multiplan All |
$848.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$512.96
|
| Rate for Payer: OMNI Networks Commercial |
$652.40
|
| Rate for Payer: One Health Plan PPO/POS |
$838.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$226.88
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$196.50
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$301.74
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$885.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$603.48
|
| Rate for Payer: Three Rivers Provider Network All |
$699.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$295.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$196.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$301.74
|
| Rate for Payer: United Payors & United Providers UP&UP |
$866.76
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$301.74
|
| Rate for Payer: Zelis Auto |
$372.80
|
| Rate for Payer: Zelis Medicare |
$256.48
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$362.09
|
| Rate for Payer: Zelis Worker's Compensation |
$254.44
|
|
