|
95812 EEG 41-60 MINUTES
|
Facility
|
OP
|
$932.00
|
|
|
Service Code
|
CPT 95812
|
| Hospital Charge Code |
21900115
|
|
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 |
$295.69
|
| 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 |
$295.69
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$838.80
|
| Rate for Payer: Humana ChoiceCare |
$325.26
|
| Rate for Payer: Humana Medicare Advantage |
$295.69
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$496.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$196.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$295.69
|
| Rate for Payer: Multiplan All |
$848.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$502.67
|
| 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 |
$295.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$885.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$591.38
|
| Rate for Payer: Three Rivers Provider Network All |
$699.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$289.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$196.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$295.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$866.76
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$295.69
|
| Rate for Payer: Zelis Auto |
$372.80
|
| Rate for Payer: Zelis Medicare |
$251.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$354.83
|
| Rate for Payer: Zelis Worker's Compensation |
$254.44
|
|
|
95812 EEG 41-60 MINUTES
|
Facility
|
IP
|
$932.00
|
|
|
Service Code
|
CPT 95812
|
| Hospital Charge Code |
21900115
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$254.44 |
| Max. Negotiated Rate |
$885.40 |
| 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 |
$652.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$838.80
|
| Rate for Payer: Multiplan All |
$848.12
|
| Rate for Payer: OMNI Networks Commercial |
$652.40
|
| Rate for Payer: One Health Plan PPO/POS |
$838.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$885.40
|
| Rate for Payer: Three Rivers Provider Network All |
$699.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$866.76
|
| Rate for Payer: Zelis Auto |
$372.80
|
| Rate for Payer: Zelis Worker's Compensation |
$254.44
|
|
|
95812 EEG 41-60 MINUTES
|
Facility
|
IP
|
$932.00
|
|
|
Service Code
|
CPT 95812
|
| Hospital Charge Code |
21700006
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$254.44 |
| Max. Negotiated Rate |
$885.40 |
| 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 |
$652.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$838.80
|
| Rate for Payer: Multiplan All |
$848.12
|
| Rate for Payer: OMNI Networks Commercial |
$652.40
|
| Rate for Payer: One Health Plan PPO/POS |
$838.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$885.40
|
| Rate for Payer: Three Rivers Provider Network All |
$699.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$866.76
|
| Rate for Payer: Zelis Auto |
$372.80
|
| Rate for Payer: Zelis Worker's Compensation |
$254.44
|
|
|
95813 EEG OVER 1 HOUR
|
Facility
|
OP
|
$1,177.00
|
|
|
Service Code
|
CPT 95813
|
| Hospital Charge Code |
21700007
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$192.58 |
| Max. Negotiated Rate |
$1,118.15 |
| 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 |
$706.20
|
| 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 |
$295.69
|
| Rate for Payer: Cash Price |
$706.20
|
| Rate for Payer: Cash Price |
$706.20
|
| Rate for Payer: Cigna Commercial |
$1,000.45
|
| Rate for Payer: First Health Commercial |
$1,059.30
|
| Rate for Payer: First Health Workers Compensation |
$454.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,059.30
|
| Rate for Payer: GEHA Commercial |
$941.60
|
| Rate for Payer: GEHA Medicare |
$295.69
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,059.30
|
| Rate for Payer: Humana ChoiceCare |
$325.26
|
| Rate for Payer: Humana Medicare Advantage |
$295.69
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$496.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$196.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$295.69
|
| Rate for Payer: Multiplan All |
$1,071.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$502.67
|
| Rate for Payer: OMNI Networks Commercial |
$823.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,059.30
|
| 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 |
$295.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,118.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$591.38
|
| Rate for Payer: Three Rivers Provider Network All |
$882.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$289.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$196.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$295.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,094.61
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$295.69
|
| Rate for Payer: Zelis Auto |
$470.80
|
| Rate for Payer: Zelis Medicare |
$251.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$354.83
|
| Rate for Payer: Zelis Worker's Compensation |
$321.32
|
|
|
95813 EEG OVER 1 HOUR
|
Facility
|
IP
|
$1,177.00
|
|
|
Service Code
|
CPT 95813
|
| Hospital Charge Code |
21700007
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$321.32 |
| Max. Negotiated Rate |
$1,118.15 |
| Rate for Payer: Cash Price |
$706.20
|
| Rate for Payer: Cigna Commercial |
$1,000.45
|
| Rate for Payer: First Health Commercial |
$1,059.30
|
| Rate for Payer: First Health Workers Compensation |
$454.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,059.30
|
| Rate for Payer: GEHA Commercial |
$823.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,059.30
|
| Rate for Payer: Multiplan All |
$1,071.07
|
| Rate for Payer: OMNI Networks Commercial |
$823.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,059.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,118.15
|
| Rate for Payer: Three Rivers Provider Network All |
$882.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,094.61
|
| Rate for Payer: Zelis Auto |
$470.80
|
| Rate for Payer: Zelis Worker's Compensation |
$321.32
|
|
|
95813 EEG OVER 1 HOUR
|
Facility
|
IP
|
$1,177.00
|
|
|
Service Code
|
CPT 95813
|
| Hospital Charge Code |
21900116
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$321.32 |
| Max. Negotiated Rate |
$1,118.15 |
| Rate for Payer: Cash Price |
$706.20
|
| Rate for Payer: Cigna Commercial |
$1,000.45
|
| Rate for Payer: First Health Commercial |
$1,059.30
|
| Rate for Payer: First Health Workers Compensation |
$454.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,059.30
|
| Rate for Payer: GEHA Commercial |
$823.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,059.30
|
| Rate for Payer: Multiplan All |
$1,071.07
|
| Rate for Payer: OMNI Networks Commercial |
$823.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,059.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,118.15
|
| Rate for Payer: Three Rivers Provider Network All |
$882.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,094.61
|
| Rate for Payer: Zelis Auto |
$470.80
|
| Rate for Payer: Zelis Worker's Compensation |
$321.32
|
|
|
95813 EEG OVER 1 HOUR
|
Facility
|
OP
|
$1,177.00
|
|
|
Service Code
|
CPT 95813
|
| Hospital Charge Code |
21900116
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$192.58 |
| Max. Negotiated Rate |
$1,118.15 |
| 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 |
$706.20
|
| 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 |
$295.69
|
| Rate for Payer: Cash Price |
$706.20
|
| Rate for Payer: Cash Price |
$706.20
|
| Rate for Payer: Cigna Commercial |
$1,000.45
|
| Rate for Payer: First Health Commercial |
$1,059.30
|
| Rate for Payer: First Health Workers Compensation |
$454.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,059.30
|
| Rate for Payer: GEHA Commercial |
$941.60
|
| Rate for Payer: GEHA Medicare |
$295.69
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,059.30
|
| Rate for Payer: Humana ChoiceCare |
$325.26
|
| Rate for Payer: Humana Medicare Advantage |
$295.69
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$496.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$196.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$295.69
|
| Rate for Payer: Multiplan All |
$1,071.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$502.67
|
| Rate for Payer: OMNI Networks Commercial |
$823.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,059.30
|
| 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 |
$295.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,118.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$591.38
|
| Rate for Payer: Three Rivers Provider Network All |
$882.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$289.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$196.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$295.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,094.61
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$295.69
|
| Rate for Payer: Zelis Auto |
$470.80
|
| Rate for Payer: Zelis Medicare |
$251.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$354.83
|
| Rate for Payer: Zelis Worker's Compensation |
$321.32
|
|
|
95816 EEG AWAKE AND DROWSY
|
Facility
|
OP
|
$1,038.00
|
|
|
Service Code
|
CPT 95816
|
| Hospital Charge Code |
21900117
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$192.58 |
| Max. Negotiated Rate |
$986.10 |
| 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 |
$622.80
|
| 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 |
$295.69
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cigna Commercial |
$882.30
|
| Rate for Payer: First Health Commercial |
$934.20
|
| Rate for Payer: First Health Workers Compensation |
$400.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$934.20
|
| Rate for Payer: GEHA Commercial |
$830.40
|
| Rate for Payer: GEHA Medicare |
$295.69
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$934.20
|
| Rate for Payer: Humana ChoiceCare |
$325.26
|
| Rate for Payer: Humana Medicare Advantage |
$295.69
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$496.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$196.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$295.69
|
| Rate for Payer: Multiplan All |
$944.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$502.67
|
| Rate for Payer: OMNI Networks Commercial |
$726.60
|
| Rate for Payer: One Health Plan PPO/POS |
$934.20
|
| 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 |
$295.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$986.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$591.38
|
| Rate for Payer: Three Rivers Provider Network All |
$778.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$289.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$196.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$295.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$965.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$295.69
|
| Rate for Payer: Zelis Auto |
$415.20
|
| Rate for Payer: Zelis Medicare |
$251.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$354.83
|
| Rate for Payer: Zelis Worker's Compensation |
$283.37
|
|
|
95816 EEG AWAKE AND DROWSY
|
Facility
|
OP
|
$1,038.00
|
|
|
Service Code
|
CPT 95816
|
| Hospital Charge Code |
21700008
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$192.58 |
| Max. Negotiated Rate |
$986.10 |
| 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 |
$622.80
|
| 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 |
$295.69
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cigna Commercial |
$882.30
|
| Rate for Payer: First Health Commercial |
$934.20
|
| Rate for Payer: First Health Workers Compensation |
$400.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$934.20
|
| Rate for Payer: GEHA Commercial |
$830.40
|
| Rate for Payer: GEHA Medicare |
$295.69
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$934.20
|
| Rate for Payer: Humana ChoiceCare |
$325.26
|
| Rate for Payer: Humana Medicare Advantage |
$295.69
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$496.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$196.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$295.69
|
| Rate for Payer: Multiplan All |
$944.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$502.67
|
| Rate for Payer: OMNI Networks Commercial |
$726.60
|
| Rate for Payer: One Health Plan PPO/POS |
$934.20
|
| 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 |
$295.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$986.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$591.38
|
| Rate for Payer: Three Rivers Provider Network All |
$778.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$289.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$196.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$295.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$965.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$295.69
|
| Rate for Payer: Zelis Auto |
$415.20
|
| Rate for Payer: Zelis Medicare |
$251.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$354.83
|
| Rate for Payer: Zelis Worker's Compensation |
$283.37
|
|
|
95816 EEG AWAKE AND DROWSY
|
Facility
|
IP
|
$1,038.00
|
|
|
Service Code
|
CPT 95816
|
| Hospital Charge Code |
21700008
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$283.37 |
| Max. Negotiated Rate |
$986.10 |
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cigna Commercial |
$882.30
|
| Rate for Payer: First Health Commercial |
$934.20
|
| Rate for Payer: First Health Workers Compensation |
$400.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$934.20
|
| Rate for Payer: GEHA Commercial |
$726.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$934.20
|
| Rate for Payer: Multiplan All |
$944.58
|
| Rate for Payer: OMNI Networks Commercial |
$726.60
|
| Rate for Payer: One Health Plan PPO/POS |
$934.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$986.10
|
| Rate for Payer: Three Rivers Provider Network All |
$778.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$965.34
|
| Rate for Payer: Zelis Auto |
$415.20
|
| Rate for Payer: Zelis Worker's Compensation |
$283.37
|
|
|
95816 EEG AWAKE AND DROWSY
|
Facility
|
IP
|
$1,038.00
|
|
|
Service Code
|
CPT 95816
|
| Hospital Charge Code |
21900117
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$283.37 |
| Max. Negotiated Rate |
$986.10 |
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cigna Commercial |
$882.30
|
| Rate for Payer: First Health Commercial |
$934.20
|
| Rate for Payer: First Health Workers Compensation |
$400.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$934.20
|
| Rate for Payer: GEHA Commercial |
$726.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$934.20
|
| Rate for Payer: Multiplan All |
$944.58
|
| Rate for Payer: OMNI Networks Commercial |
$726.60
|
| Rate for Payer: One Health Plan PPO/POS |
$934.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$986.10
|
| Rate for Payer: Three Rivers Provider Network All |
$778.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$965.34
|
| Rate for Payer: Zelis Auto |
$415.20
|
| Rate for Payer: Zelis Worker's Compensation |
$283.37
|
|
|
95819 EEG AWAKE AND ASLEEP
|
Facility
|
IP
|
$1,193.00
|
|
|
Service Code
|
CPT 95819
|
| Hospital Charge Code |
21700009
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$325.69 |
| Max. Negotiated Rate |
$1,133.35 |
| Rate for Payer: Cash Price |
$715.80
|
| Rate for Payer: Cigna Commercial |
$1,014.05
|
| Rate for Payer: First Health Commercial |
$1,073.70
|
| Rate for Payer: First Health Workers Compensation |
$460.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,073.70
|
| Rate for Payer: GEHA Commercial |
$835.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,073.70
|
| Rate for Payer: Multiplan All |
$1,085.63
|
| Rate for Payer: OMNI Networks Commercial |
$835.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,073.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,133.35
|
| Rate for Payer: Three Rivers Provider Network All |
$894.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,109.49
|
| Rate for Payer: Zelis Auto |
$477.20
|
| Rate for Payer: Zelis Worker's Compensation |
$325.69
|
|
|
95819 EEG AWAKE AND ASLEEP
|
Facility
|
IP
|
$1,193.00
|
|
|
Service Code
|
CPT 95819
|
| Hospital Charge Code |
21900118
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$325.69 |
| Max. Negotiated Rate |
$1,133.35 |
| Rate for Payer: Cash Price |
$715.80
|
| Rate for Payer: Cigna Commercial |
$1,014.05
|
| Rate for Payer: First Health Commercial |
$1,073.70
|
| Rate for Payer: First Health Workers Compensation |
$460.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,073.70
|
| Rate for Payer: GEHA Commercial |
$835.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,073.70
|
| Rate for Payer: Multiplan All |
$1,085.63
|
| Rate for Payer: OMNI Networks Commercial |
$835.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,073.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,133.35
|
| Rate for Payer: Three Rivers Provider Network All |
$894.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,109.49
|
| Rate for Payer: Zelis Auto |
$477.20
|
| Rate for Payer: Zelis Worker's Compensation |
$325.69
|
|
|
95819 EEG AWAKE AND ASLEEP
|
Facility
|
OP
|
$1,193.00
|
|
|
Service Code
|
CPT 95819
|
| Hospital Charge Code |
21700009
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$192.58 |
| Max. Negotiated Rate |
$1,133.35 |
| 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 |
$715.80
|
| 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 |
$295.69
|
| Rate for Payer: Cash Price |
$715.80
|
| Rate for Payer: Cash Price |
$715.80
|
| Rate for Payer: Cigna Commercial |
$1,014.05
|
| Rate for Payer: First Health Commercial |
$1,073.70
|
| Rate for Payer: First Health Workers Compensation |
$460.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,073.70
|
| Rate for Payer: GEHA Commercial |
$954.40
|
| Rate for Payer: GEHA Medicare |
$295.69
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,073.70
|
| Rate for Payer: Humana ChoiceCare |
$325.26
|
| Rate for Payer: Humana Medicare Advantage |
$295.69
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$496.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$196.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$295.69
|
| Rate for Payer: Multiplan All |
$1,085.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$502.67
|
| Rate for Payer: OMNI Networks Commercial |
$835.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,073.70
|
| 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 |
$295.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,133.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$591.38
|
| Rate for Payer: Three Rivers Provider Network All |
$894.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$289.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$196.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$295.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,109.49
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$295.69
|
| Rate for Payer: Zelis Auto |
$477.20
|
| Rate for Payer: Zelis Medicare |
$251.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$354.83
|
| Rate for Payer: Zelis Worker's Compensation |
$325.69
|
|
|
95819 EEG AWAKE AND ASLEEP
|
Facility
|
OP
|
$1,193.00
|
|
|
Service Code
|
CPT 95819
|
| Hospital Charge Code |
21900118
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$192.58 |
| Max. Negotiated Rate |
$1,133.35 |
| 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 |
$715.80
|
| 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 |
$295.69
|
| Rate for Payer: Cash Price |
$715.80
|
| Rate for Payer: Cash Price |
$715.80
|
| Rate for Payer: Cigna Commercial |
$1,014.05
|
| Rate for Payer: First Health Commercial |
$1,073.70
|
| Rate for Payer: First Health Workers Compensation |
$460.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,073.70
|
| Rate for Payer: GEHA Commercial |
$954.40
|
| Rate for Payer: GEHA Medicare |
$295.69
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,073.70
|
| Rate for Payer: Humana ChoiceCare |
$325.26
|
| Rate for Payer: Humana Medicare Advantage |
$295.69
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$496.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$196.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$295.69
|
| Rate for Payer: Multiplan All |
$1,085.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$502.67
|
| Rate for Payer: OMNI Networks Commercial |
$835.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,073.70
|
| 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 |
$295.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,133.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$591.38
|
| Rate for Payer: Three Rivers Provider Network All |
$894.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$289.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$196.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$295.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,109.49
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$295.69
|
| Rate for Payer: Zelis Auto |
$477.20
|
| Rate for Payer: Zelis Medicare |
$251.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$354.83
|
| Rate for Payer: Zelis Worker's Compensation |
$325.69
|
|
|
95831 LIMB MUSCLE TESTING MANUAL
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
CPT 95831
|
| Hospital Charge Code |
21700010
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.39 |
| Max. Negotiated Rate |
$88.35 |
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$79.05
|
| Rate for Payer: First Health Commercial |
$83.70
|
| Rate for Payer: First Health Workers Compensation |
$35.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$83.70
|
| Rate for Payer: GEHA Commercial |
$65.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$83.70
|
| Rate for Payer: Multiplan All |
$84.63
|
| Rate for Payer: OMNI Networks Commercial |
$65.10
|
| Rate for Payer: One Health Plan PPO/POS |
$83.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$88.35
|
| Rate for Payer: Three Rivers Provider Network All |
$69.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$86.49
|
| Rate for Payer: Zelis Auto |
$37.20
|
| Rate for Payer: Zelis Worker's Compensation |
$25.39
|
|
|
95831 LIMB MUSCLE TESTING MANUAL
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
CPT 95831
|
| Hospital Charge Code |
21900119
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.39 |
| Max. Negotiated Rate |
$88.35 |
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$79.05
|
| Rate for Payer: First Health Commercial |
$83.70
|
| Rate for Payer: First Health Workers Compensation |
$35.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$83.70
|
| Rate for Payer: GEHA Commercial |
$65.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$83.70
|
| Rate for Payer: Multiplan All |
$84.63
|
| Rate for Payer: OMNI Networks Commercial |
$65.10
|
| Rate for Payer: One Health Plan PPO/POS |
$83.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$88.35
|
| Rate for Payer: Three Rivers Provider Network All |
$69.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$86.49
|
| Rate for Payer: Zelis Auto |
$37.20
|
| Rate for Payer: Zelis Worker's Compensation |
$25.39
|
|
|
95831 LIMB MUSCLE TESTING MANUAL
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
CPT 95831
|
| Hospital Charge Code |
21900119
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.25 |
| Max. Negotiated Rate |
$88.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$79.05
|
| Rate for Payer: First Health Commercial |
$83.70
|
| Rate for Payer: First Health Workers Compensation |
$35.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$83.70
|
| Rate for Payer: GEHA Commercial |
$74.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$83.70
|
| Rate for Payer: Humana ChoiceCare |
$24.18
|
| Rate for Payer: Multiplan All |
$84.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$55.80
|
| Rate for Payer: OMNI Networks Commercial |
$65.10
|
| Rate for Payer: One Health Plan PPO/POS |
$83.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$88.35
|
| Rate for Payer: Three Rivers Provider Network All |
$69.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$23.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$86.49
|
| Rate for Payer: Zelis Auto |
$37.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$46.50
|
| Rate for Payer: Zelis Worker's Compensation |
$25.39
|
|
|
95831 LIMB MUSCLE TESTING MANUAL
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
CPT 95831
|
| Hospital Charge Code |
21700010
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.25 |
| Max. Negotiated Rate |
$88.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$79.05
|
| Rate for Payer: First Health Commercial |
$83.70
|
| Rate for Payer: First Health Workers Compensation |
$35.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$83.70
|
| Rate for Payer: GEHA Commercial |
$74.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$83.70
|
| Rate for Payer: Humana ChoiceCare |
$24.18
|
| Rate for Payer: Multiplan All |
$84.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$55.80
|
| Rate for Payer: OMNI Networks Commercial |
$65.10
|
| Rate for Payer: One Health Plan PPO/POS |
$83.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$88.35
|
| Rate for Payer: Three Rivers Provider Network All |
$69.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$23.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$86.49
|
| Rate for Payer: Zelis Auto |
$37.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$46.50
|
| Rate for Payer: Zelis Worker's Compensation |
$25.39
|
|
|
95860 MUSCLE TEST ONE LIMB
|
Facility
|
IP
|
$358.00
|
|
|
Service Code
|
CPT 95860
|
| Hospital Charge Code |
21700011
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$97.73 |
| Max. Negotiated Rate |
$340.10 |
| Rate for Payer: Cash Price |
$214.80
|
| Rate for Payer: Cigna Commercial |
$304.30
|
| Rate for Payer: First Health Commercial |
$322.20
|
| Rate for Payer: First Health Workers Compensation |
$138.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$322.20
|
| Rate for Payer: GEHA Commercial |
$250.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$322.20
|
| Rate for Payer: Multiplan All |
$325.78
|
| Rate for Payer: OMNI Networks Commercial |
$250.60
|
| Rate for Payer: One Health Plan PPO/POS |
$322.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$340.10
|
| Rate for Payer: Three Rivers Provider Network All |
$268.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$332.94
|
| Rate for Payer: Zelis Auto |
$143.20
|
| Rate for Payer: Zelis Worker's Compensation |
$97.73
|
|
|
95860 MUSCLE TEST ONE LIMB
|
Facility
|
OP
|
$358.00
|
|
|
Service Code
|
CPT 95860
|
| Hospital Charge Code |
21700011
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$97.73 |
| Max. Negotiated Rate |
$340.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$142.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$214.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$142.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$112.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$214.80
|
| Rate for Payer: Cash Price |
$214.80
|
| Rate for Payer: Cigna Commercial |
$304.30
|
| Rate for Payer: First Health Commercial |
$322.20
|
| Rate for Payer: First Health Workers Compensation |
$138.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$322.20
|
| Rate for Payer: GEHA Commercial |
$286.40
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$322.20
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$115.10
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$325.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$250.60
|
| Rate for Payer: One Health Plan PPO/POS |
$322.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$132.90
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$115.10
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$340.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$268.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$332.94
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$143.20
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$97.73
|
|
|
95860 MUSCLE TEST ONE LIMB
|
Facility
|
OP
|
$358.00
|
|
|
Service Code
|
CPT 95860
|
| Hospital Charge Code |
21900120
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$97.73 |
| Max. Negotiated Rate |
$340.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$142.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$214.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$142.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$112.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$214.80
|
| Rate for Payer: Cash Price |
$214.80
|
| Rate for Payer: Cigna Commercial |
$304.30
|
| Rate for Payer: First Health Commercial |
$322.20
|
| Rate for Payer: First Health Workers Compensation |
$138.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$322.20
|
| Rate for Payer: GEHA Commercial |
$286.40
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$322.20
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$115.10
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$325.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$250.60
|
| Rate for Payer: One Health Plan PPO/POS |
$322.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$132.90
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$115.10
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$340.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$268.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$332.94
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$143.20
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$97.73
|
|
|
95860 MUSCLE TEST ONE LIMB
|
Facility
|
IP
|
$358.00
|
|
|
Service Code
|
CPT 95860
|
| Hospital Charge Code |
21900120
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$97.73 |
| Max. Negotiated Rate |
$340.10 |
| Rate for Payer: Cash Price |
$214.80
|
| Rate for Payer: Cigna Commercial |
$304.30
|
| Rate for Payer: First Health Commercial |
$322.20
|
| Rate for Payer: First Health Workers Compensation |
$138.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$322.20
|
| Rate for Payer: GEHA Commercial |
$250.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$322.20
|
| Rate for Payer: Multiplan All |
$325.78
|
| Rate for Payer: OMNI Networks Commercial |
$250.60
|
| Rate for Payer: One Health Plan PPO/POS |
$322.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$340.10
|
| Rate for Payer: Three Rivers Provider Network All |
$268.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$332.94
|
| Rate for Payer: Zelis Auto |
$143.20
|
| Rate for Payer: Zelis Worker's Compensation |
$97.73
|
|
|
95861 MUSCLE TEST 2 LIMBS
|
Facility
|
OP
|
$512.00
|
|
|
Service Code
|
CPT 95861
|
| Hospital Charge Code |
21700012
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$95.84 |
| Max. Negotiated Rate |
$486.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$120.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$307.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$120.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$95.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cigna Commercial |
$435.20
|
| Rate for Payer: First Health Commercial |
$460.80
|
| Rate for Payer: First Health Workers Compensation |
$197.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$460.80
|
| Rate for Payer: GEHA Commercial |
$409.60
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$460.80
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$97.79
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$465.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$358.40
|
| Rate for Payer: One Health Plan PPO/POS |
$460.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$112.91
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$97.79
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$486.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$384.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$97.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$476.16
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$204.80
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$139.78
|
|
|
95861 MUSCLE TEST 2 LIMBS
|
Facility
|
OP
|
$512.00
|
|
|
Service Code
|
CPT 95861
|
| Hospital Charge Code |
21900121
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$95.84 |
| Max. Negotiated Rate |
$486.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$120.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$307.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$120.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$95.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cigna Commercial |
$435.20
|
| Rate for Payer: First Health Commercial |
$460.80
|
| Rate for Payer: First Health Workers Compensation |
$197.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$460.80
|
| Rate for Payer: GEHA Commercial |
$409.60
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$460.80
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$97.79
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$465.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$358.40
|
| Rate for Payer: One Health Plan PPO/POS |
$460.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$112.91
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$97.79
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$486.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$384.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$97.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$476.16
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$204.80
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$139.78
|
|
