|
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 |
$124.90
|
| 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 |
$124.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$460.80
|
| Rate for Payer: Humana ChoiceCare |
$137.39
|
| Rate for Payer: Humana Medicare Advantage |
$124.90
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$209.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$97.79
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$124.90
|
| Rate for Payer: Multiplan All |
$465.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$212.33
|
| 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 |
$124.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$486.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$249.80
|
| Rate for Payer: Three Rivers Provider Network All |
$384.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$122.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$97.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$124.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$476.16
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$124.90
|
| Rate for Payer: Zelis Auto |
$204.80
|
| Rate for Payer: Zelis Medicare |
$106.17
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$149.88
|
| 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 |
$124.90
|
| 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 |
$124.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$460.80
|
| Rate for Payer: Humana ChoiceCare |
$137.39
|
| Rate for Payer: Humana Medicare Advantage |
$124.90
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$209.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$97.79
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$124.90
|
| Rate for Payer: Multiplan All |
$465.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$212.33
|
| 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 |
$124.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$486.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$249.80
|
| Rate for Payer: Three Rivers Provider Network All |
$384.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$122.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$97.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$124.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$476.16
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$124.90
|
| Rate for Payer: Zelis Auto |
$204.80
|
| Rate for Payer: Zelis Medicare |
$106.17
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$149.88
|
| Rate for Payer: Zelis Worker's Compensation |
$139.78
|
|
|
95863 MUSCLE TEST 3 LIMBS
|
Facility
|
OP
|
$640.00
|
|
|
Service Code
|
CPT 95863
|
| Hospital Charge Code |
21700013
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$95.84 |
| Max. Negotiated Rate |
$608.00 |
| 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 |
$384.00
|
| 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 |
$151.61
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cigna Commercial |
$544.00
|
| Rate for Payer: First Health Commercial |
$576.00
|
| Rate for Payer: First Health Workers Compensation |
$247.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$576.00
|
| Rate for Payer: GEHA Commercial |
$512.00
|
| Rate for Payer: GEHA Medicare |
$151.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$576.00
|
| Rate for Payer: Humana ChoiceCare |
$166.77
|
| Rate for Payer: Humana Medicare Advantage |
$151.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$254.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$97.79
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$151.61
|
| Rate for Payer: Multiplan All |
$582.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$257.74
|
| Rate for Payer: OMNI Networks Commercial |
$448.00
|
| Rate for Payer: One Health Plan PPO/POS |
$576.00
|
| 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 |
$151.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$608.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$303.22
|
| Rate for Payer: Three Rivers Provider Network All |
$480.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$148.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$97.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$151.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$595.20
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$151.61
|
| Rate for Payer: Zelis Auto |
$256.00
|
| Rate for Payer: Zelis Medicare |
$128.87
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$181.93
|
| Rate for Payer: Zelis Worker's Compensation |
$174.72
|
|
|
95863 MUSCLE TEST 3 LIMBS
|
Facility
|
IP
|
$640.00
|
|
|
Service Code
|
CPT 95863
|
| Hospital Charge Code |
21900122
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$174.72 |
| Max. Negotiated Rate |
$608.00 |
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cigna Commercial |
$544.00
|
| Rate for Payer: First Health Commercial |
$576.00
|
| Rate for Payer: First Health Workers Compensation |
$247.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$576.00
|
| Rate for Payer: GEHA Commercial |
$448.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$576.00
|
| Rate for Payer: Multiplan All |
$582.40
|
| Rate for Payer: OMNI Networks Commercial |
$448.00
|
| Rate for Payer: One Health Plan PPO/POS |
$576.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$608.00
|
| Rate for Payer: Three Rivers Provider Network All |
$480.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$595.20
|
| Rate for Payer: Zelis Auto |
$256.00
|
| Rate for Payer: Zelis Worker's Compensation |
$174.72
|
|
|
95863 MUSCLE TEST 3 LIMBS
|
Facility
|
IP
|
$640.00
|
|
|
Service Code
|
CPT 95863
|
| Hospital Charge Code |
21700013
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$174.72 |
| Max. Negotiated Rate |
$608.00 |
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cigna Commercial |
$544.00
|
| Rate for Payer: First Health Commercial |
$576.00
|
| Rate for Payer: First Health Workers Compensation |
$247.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$576.00
|
| Rate for Payer: GEHA Commercial |
$448.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$576.00
|
| Rate for Payer: Multiplan All |
$582.40
|
| Rate for Payer: OMNI Networks Commercial |
$448.00
|
| Rate for Payer: One Health Plan PPO/POS |
$576.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$608.00
|
| Rate for Payer: Three Rivers Provider Network All |
$480.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$595.20
|
| Rate for Payer: Zelis Auto |
$256.00
|
| Rate for Payer: Zelis Worker's Compensation |
$174.72
|
|
|
95863 MUSCLE TEST 3 LIMBS
|
Facility
|
OP
|
$640.00
|
|
|
Service Code
|
CPT 95863
|
| Hospital Charge Code |
21900122
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$95.84 |
| Max. Negotiated Rate |
$608.00 |
| 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 |
$384.00
|
| 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 |
$151.61
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cigna Commercial |
$544.00
|
| Rate for Payer: First Health Commercial |
$576.00
|
| Rate for Payer: First Health Workers Compensation |
$247.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$576.00
|
| Rate for Payer: GEHA Commercial |
$512.00
|
| Rate for Payer: GEHA Medicare |
$151.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$576.00
|
| Rate for Payer: Humana ChoiceCare |
$166.77
|
| Rate for Payer: Humana Medicare Advantage |
$151.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$254.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$97.79
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$151.61
|
| Rate for Payer: Multiplan All |
$582.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$257.74
|
| Rate for Payer: OMNI Networks Commercial |
$448.00
|
| Rate for Payer: One Health Plan PPO/POS |
$576.00
|
| 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 |
$151.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$608.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$303.22
|
| Rate for Payer: Three Rivers Provider Network All |
$480.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$148.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$97.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$151.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$595.20
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$151.61
|
| Rate for Payer: Zelis Auto |
$256.00
|
| Rate for Payer: Zelis Medicare |
$128.87
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$181.93
|
| Rate for Payer: Zelis Worker's Compensation |
$174.72
|
|
|
95864 MUSCLE TEST 4 LIMBS
|
Facility
|
IP
|
$720.00
|
|
|
Service Code
|
CPT 95864
|
| Hospital Charge Code |
21900123
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$196.56 |
| Max. Negotiated Rate |
$684.00 |
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cigna Commercial |
$612.00
|
| Rate for Payer: First Health Commercial |
$648.00
|
| Rate for Payer: First Health Workers Compensation |
$277.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$648.00
|
| Rate for Payer: GEHA Commercial |
$504.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$648.00
|
| Rate for Payer: Multiplan All |
$655.20
|
| Rate for Payer: OMNI Networks Commercial |
$504.00
|
| Rate for Payer: One Health Plan PPO/POS |
$648.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$684.00
|
| Rate for Payer: Three Rivers Provider Network All |
$540.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$669.60
|
| Rate for Payer: Zelis Auto |
$288.00
|
| Rate for Payer: Zelis Worker's Compensation |
$196.56
|
|
|
95864 MUSCLE TEST 4 LIMBS
|
Facility
|
IP
|
$720.00
|
|
|
Service Code
|
CPT 95864
|
| Hospital Charge Code |
21700014
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$196.56 |
| Max. Negotiated Rate |
$684.00 |
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cigna Commercial |
$612.00
|
| Rate for Payer: First Health Commercial |
$648.00
|
| Rate for Payer: First Health Workers Compensation |
$277.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$648.00
|
| Rate for Payer: GEHA Commercial |
$504.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$648.00
|
| Rate for Payer: Multiplan All |
$655.20
|
| Rate for Payer: OMNI Networks Commercial |
$504.00
|
| Rate for Payer: One Health Plan PPO/POS |
$648.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$684.00
|
| Rate for Payer: Three Rivers Provider Network All |
$540.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$669.60
|
| Rate for Payer: Zelis Auto |
$288.00
|
| Rate for Payer: Zelis Worker's Compensation |
$196.56
|
|
|
95864 MUSCLE TEST 4 LIMBS
|
Facility
|
OP
|
$720.00
|
|
|
Service Code
|
CPT 95864
|
| Hospital Charge Code |
21900123
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$95.84 |
| Max. Negotiated Rate |
$684.00 |
| 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 |
$432.00
|
| 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 |
$151.61
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cigna Commercial |
$612.00
|
| Rate for Payer: First Health Commercial |
$648.00
|
| Rate for Payer: First Health Workers Compensation |
$277.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$648.00
|
| Rate for Payer: GEHA Commercial |
$576.00
|
| Rate for Payer: GEHA Medicare |
$151.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$648.00
|
| Rate for Payer: Humana ChoiceCare |
$166.77
|
| Rate for Payer: Humana Medicare Advantage |
$151.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$254.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$97.79
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$151.61
|
| Rate for Payer: Multiplan All |
$655.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$257.74
|
| Rate for Payer: OMNI Networks Commercial |
$504.00
|
| Rate for Payer: One Health Plan PPO/POS |
$648.00
|
| 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 |
$151.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$684.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$303.22
|
| Rate for Payer: Three Rivers Provider Network All |
$540.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$148.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$97.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$151.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$669.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$151.61
|
| Rate for Payer: Zelis Auto |
$288.00
|
| Rate for Payer: Zelis Medicare |
$128.87
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$181.93
|
| Rate for Payer: Zelis Worker's Compensation |
$196.56
|
|
|
95864 MUSCLE TEST 4 LIMBS
|
Facility
|
OP
|
$720.00
|
|
|
Service Code
|
CPT 95864
|
| Hospital Charge Code |
21700014
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$95.84 |
| Max. Negotiated Rate |
$684.00 |
| 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 |
$432.00
|
| 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 |
$151.61
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cigna Commercial |
$612.00
|
| Rate for Payer: First Health Commercial |
$648.00
|
| Rate for Payer: First Health Workers Compensation |
$277.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$648.00
|
| Rate for Payer: GEHA Commercial |
$576.00
|
| Rate for Payer: GEHA Medicare |
$151.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$648.00
|
| Rate for Payer: Humana ChoiceCare |
$166.77
|
| Rate for Payer: Humana Medicare Advantage |
$151.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$254.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$97.79
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$151.61
|
| Rate for Payer: Multiplan All |
$655.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$257.74
|
| Rate for Payer: OMNI Networks Commercial |
$504.00
|
| Rate for Payer: One Health Plan PPO/POS |
$648.00
|
| 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 |
$151.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$684.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$303.22
|
| Rate for Payer: Three Rivers Provider Network All |
$540.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$148.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$97.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$151.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$669.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$151.61
|
| Rate for Payer: Zelis Auto |
$288.00
|
| Rate for Payer: Zelis Medicare |
$128.87
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$181.93
|
| Rate for Payer: Zelis Worker's Compensation |
$196.56
|
|
|
95869 MUSCLE TEST THOR PARASPINAL
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
CPT 95869
|
| Hospital Charge Code |
21700015
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$72.34 |
| Max. Negotiated Rate |
$603.48 |
| 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 |
$159.00
|
| 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 |
$301.74
|
| Rate for Payer: Cash Price |
$159.00
|
| Rate for Payer: Cash Price |
$159.00
|
| Rate for Payer: Cigna Commercial |
$225.25
|
| Rate for Payer: First Health Commercial |
$238.50
|
| Rate for Payer: First Health Workers Compensation |
$102.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$238.50
|
| Rate for Payer: GEHA Commercial |
$212.00
|
| Rate for Payer: GEHA Medicare |
$301.74
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$238.50
|
| 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 |
$115.10
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$301.74
|
| Rate for Payer: Multiplan All |
$241.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$512.96
|
| Rate for Payer: OMNI Networks Commercial |
$185.50
|
| Rate for Payer: One Health Plan PPO/POS |
$238.50
|
| 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 |
$301.74
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$251.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$603.48
|
| Rate for Payer: Three Rivers Provider Network All |
$198.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$295.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$301.74
|
| Rate for Payer: United Payors & United Providers UP&UP |
$246.45
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$301.74
|
| Rate for Payer: Zelis Auto |
$106.00
|
| Rate for Payer: Zelis Medicare |
$256.48
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$362.09
|
| Rate for Payer: Zelis Worker's Compensation |
$72.34
|
|
|
95869 MUSCLE TEST THOR PARASPINAL
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT 95869
|
| Hospital Charge Code |
21700015
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$72.34 |
| Max. Negotiated Rate |
$251.75 |
| Rate for Payer: Cash Price |
$159.00
|
| Rate for Payer: Cigna Commercial |
$225.25
|
| Rate for Payer: First Health Commercial |
$238.50
|
| Rate for Payer: First Health Workers Compensation |
$102.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$238.50
|
| Rate for Payer: GEHA Commercial |
$185.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$238.50
|
| Rate for Payer: Multiplan All |
$241.15
|
| Rate for Payer: OMNI Networks Commercial |
$185.50
|
| Rate for Payer: One Health Plan PPO/POS |
$238.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$251.75
|
| Rate for Payer: Three Rivers Provider Network All |
$198.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$246.45
|
| Rate for Payer: Zelis Auto |
$106.00
|
| Rate for Payer: Zelis Worker's Compensation |
$72.34
|
|
|
95869 MUSCLE TEST THOR PARASPINAL
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
CPT 95869
|
| Hospital Charge Code |
21900124
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$72.34 |
| Max. Negotiated Rate |
$603.48 |
| 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 |
$159.00
|
| 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 |
$301.74
|
| Rate for Payer: Cash Price |
$159.00
|
| Rate for Payer: Cash Price |
$159.00
|
| Rate for Payer: Cigna Commercial |
$225.25
|
| Rate for Payer: First Health Commercial |
$238.50
|
| Rate for Payer: First Health Workers Compensation |
$102.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$238.50
|
| Rate for Payer: GEHA Commercial |
$212.00
|
| Rate for Payer: GEHA Medicare |
$301.74
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$238.50
|
| 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 |
$115.10
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$301.74
|
| Rate for Payer: Multiplan All |
$241.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$512.96
|
| Rate for Payer: OMNI Networks Commercial |
$185.50
|
| Rate for Payer: One Health Plan PPO/POS |
$238.50
|
| 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 |
$301.74
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$251.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$603.48
|
| Rate for Payer: Three Rivers Provider Network All |
$198.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$295.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$301.74
|
| Rate for Payer: United Payors & United Providers UP&UP |
$246.45
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$301.74
|
| Rate for Payer: Zelis Auto |
$106.00
|
| Rate for Payer: Zelis Medicare |
$256.48
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$362.09
|
| Rate for Payer: Zelis Worker's Compensation |
$72.34
|
|
|
95869 MUSCLE TEST THOR PARASPINAL
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT 95869
|
| Hospital Charge Code |
21900124
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$72.34 |
| Max. Negotiated Rate |
$251.75 |
| Rate for Payer: Cash Price |
$159.00
|
| Rate for Payer: Cigna Commercial |
$225.25
|
| Rate for Payer: First Health Commercial |
$238.50
|
| Rate for Payer: First Health Workers Compensation |
$102.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$238.50
|
| Rate for Payer: GEHA Commercial |
$185.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$238.50
|
| Rate for Payer: Multiplan All |
$241.15
|
| Rate for Payer: OMNI Networks Commercial |
$185.50
|
| Rate for Payer: One Health Plan PPO/POS |
$238.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$251.75
|
| Rate for Payer: Three Rivers Provider Network All |
$198.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$246.45
|
| Rate for Payer: Zelis Auto |
$106.00
|
| Rate for Payer: Zelis Worker's Compensation |
$72.34
|
|
|
95870 MUSCLE TEST NONPARASPINAL
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT 95870
|
| Hospital Charge Code |
21900125
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.21 |
| Max. Negotiated Rate |
$254.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$160.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$62.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$124.90
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cigna Commercial |
$227.80
|
| Rate for Payer: First Health Commercial |
$241.20
|
| Rate for Payer: First Health Workers Compensation |
$103.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$241.20
|
| Rate for Payer: GEHA Commercial |
$214.40
|
| Rate for Payer: GEHA Medicare |
$124.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$241.20
|
| Rate for Payer: Humana ChoiceCare |
$137.39
|
| Rate for Payer: Humana Medicare Advantage |
$124.90
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$209.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$63.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$124.90
|
| Rate for Payer: Multiplan All |
$243.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$212.33
|
| Rate for Payer: OMNI Networks Commercial |
$187.60
|
| Rate for Payer: One Health Plan PPO/POS |
$241.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$73.29
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$63.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$124.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$254.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$249.80
|
| Rate for Payer: Three Rivers Provider Network All |
$201.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$122.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$124.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$249.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$124.90
|
| Rate for Payer: Zelis Auto |
$107.20
|
| Rate for Payer: Zelis Medicare |
$106.17
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$149.88
|
| Rate for Payer: Zelis Worker's Compensation |
$73.16
|
|
|
95870 MUSCLE TEST NONPARASPINAL
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT 95870
|
| Hospital Charge Code |
21700016
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.21 |
| Max. Negotiated Rate |
$254.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$160.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$62.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$124.90
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cigna Commercial |
$227.80
|
| Rate for Payer: First Health Commercial |
$241.20
|
| Rate for Payer: First Health Workers Compensation |
$103.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$241.20
|
| Rate for Payer: GEHA Commercial |
$214.40
|
| Rate for Payer: GEHA Medicare |
$124.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$241.20
|
| Rate for Payer: Humana ChoiceCare |
$137.39
|
| Rate for Payer: Humana Medicare Advantage |
$124.90
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$209.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$63.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$124.90
|
| Rate for Payer: Multiplan All |
$243.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$212.33
|
| Rate for Payer: OMNI Networks Commercial |
$187.60
|
| Rate for Payer: One Health Plan PPO/POS |
$241.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$73.29
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$63.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$124.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$254.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$249.80
|
| Rate for Payer: Three Rivers Provider Network All |
$201.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$122.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$124.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$249.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$124.90
|
| Rate for Payer: Zelis Auto |
$107.20
|
| Rate for Payer: Zelis Medicare |
$106.17
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$149.88
|
| Rate for Payer: Zelis Worker's Compensation |
$73.16
|
|
|
95870 MUSCLE TEST NONPARASPINAL
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT 95870
|
| Hospital Charge Code |
21900125
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$73.16 |
| Max. Negotiated Rate |
$254.60 |
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cigna Commercial |
$227.80
|
| Rate for Payer: First Health Commercial |
$241.20
|
| Rate for Payer: First Health Workers Compensation |
$103.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$241.20
|
| Rate for Payer: GEHA Commercial |
$187.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$241.20
|
| Rate for Payer: Multiplan All |
$243.88
|
| Rate for Payer: OMNI Networks Commercial |
$187.60
|
| Rate for Payer: One Health Plan PPO/POS |
$241.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$254.60
|
| Rate for Payer: Three Rivers Provider Network All |
$201.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$249.24
|
| Rate for Payer: Zelis Auto |
$107.20
|
| Rate for Payer: Zelis Worker's Compensation |
$73.16
|
|
|
95870 MUSCLE TEST NONPARASPINAL
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT 95870
|
| Hospital Charge Code |
21700016
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$73.16 |
| Max. Negotiated Rate |
$254.60 |
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cigna Commercial |
$227.80
|
| Rate for Payer: First Health Commercial |
$241.20
|
| Rate for Payer: First Health Workers Compensation |
$103.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$241.20
|
| Rate for Payer: GEHA Commercial |
$187.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$241.20
|
| Rate for Payer: Multiplan All |
$243.88
|
| Rate for Payer: OMNI Networks Commercial |
$187.60
|
| Rate for Payer: One Health Plan PPO/POS |
$241.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$254.60
|
| Rate for Payer: Three Rivers Provider Network All |
$201.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$249.24
|
| Rate for Payer: Zelis Auto |
$107.20
|
| Rate for Payer: Zelis Worker's Compensation |
$73.16
|
|
|
95875 LIMB EXERCISE TEST
|
Facility
|
OP
|
$345.00
|
|
|
Service Code
|
CPT 95875
|
| Hospital Charge Code |
21700017
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.14 |
| Max. Negotiated Rate |
$327.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$62.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$207.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$62.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$49.14
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$151.61
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cigna Commercial |
$293.25
|
| Rate for Payer: First Health Commercial |
$310.50
|
| Rate for Payer: First Health Workers Compensation |
$133.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$310.50
|
| Rate for Payer: GEHA Commercial |
$276.00
|
| Rate for Payer: GEHA Medicare |
$151.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$310.50
|
| Rate for Payer: Humana ChoiceCare |
$166.77
|
| Rate for Payer: Humana Medicare Advantage |
$151.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$254.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$50.14
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$151.61
|
| Rate for Payer: Multiplan All |
$313.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$257.74
|
| Rate for Payer: OMNI Networks Commercial |
$241.50
|
| Rate for Payer: One Health Plan PPO/POS |
$310.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$57.89
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$50.14
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$151.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$327.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$303.22
|
| Rate for Payer: Three Rivers Provider Network All |
$258.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$148.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$50.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$151.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$320.85
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$151.61
|
| Rate for Payer: Zelis Auto |
$138.00
|
| Rate for Payer: Zelis Medicare |
$128.87
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$181.93
|
| Rate for Payer: Zelis Worker's Compensation |
$94.19
|
|
|
95875 LIMB EXERCISE TEST
|
Facility
|
IP
|
$345.00
|
|
|
Service Code
|
CPT 95875
|
| Hospital Charge Code |
21900126
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$94.19 |
| Max. Negotiated Rate |
$327.75 |
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cigna Commercial |
$293.25
|
| Rate for Payer: First Health Commercial |
$310.50
|
| Rate for Payer: First Health Workers Compensation |
$133.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$310.50
|
| Rate for Payer: GEHA Commercial |
$241.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$310.50
|
| Rate for Payer: Multiplan All |
$313.95
|
| Rate for Payer: OMNI Networks Commercial |
$241.50
|
| Rate for Payer: One Health Plan PPO/POS |
$310.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$327.75
|
| Rate for Payer: Three Rivers Provider Network All |
$258.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$320.85
|
| Rate for Payer: Zelis Auto |
$138.00
|
| Rate for Payer: Zelis Worker's Compensation |
$94.19
|
|
|
95875 LIMB EXERCISE TEST
|
Facility
|
IP
|
$345.00
|
|
|
Service Code
|
CPT 95875
|
| Hospital Charge Code |
21700017
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$94.19 |
| Max. Negotiated Rate |
$327.75 |
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cigna Commercial |
$293.25
|
| Rate for Payer: First Health Commercial |
$310.50
|
| Rate for Payer: First Health Workers Compensation |
$133.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$310.50
|
| Rate for Payer: GEHA Commercial |
$241.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$310.50
|
| Rate for Payer: Multiplan All |
$313.95
|
| Rate for Payer: OMNI Networks Commercial |
$241.50
|
| Rate for Payer: One Health Plan PPO/POS |
$310.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$327.75
|
| Rate for Payer: Three Rivers Provider Network All |
$258.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$320.85
|
| Rate for Payer: Zelis Auto |
$138.00
|
| Rate for Payer: Zelis Worker's Compensation |
$94.19
|
|
|
95875 LIMB EXERCISE TEST
|
Facility
|
OP
|
$345.00
|
|
|
Service Code
|
CPT 95875
|
| Hospital Charge Code |
21900126
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.14 |
| Max. Negotiated Rate |
$327.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$62.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$207.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$62.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$49.14
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$151.61
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cigna Commercial |
$293.25
|
| Rate for Payer: First Health Commercial |
$310.50
|
| Rate for Payer: First Health Workers Compensation |
$133.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$310.50
|
| Rate for Payer: GEHA Commercial |
$276.00
|
| Rate for Payer: GEHA Medicare |
$151.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$310.50
|
| Rate for Payer: Humana ChoiceCare |
$166.77
|
| Rate for Payer: Humana Medicare Advantage |
$151.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$254.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$50.14
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$151.61
|
| Rate for Payer: Multiplan All |
$313.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$257.74
|
| Rate for Payer: OMNI Networks Commercial |
$241.50
|
| Rate for Payer: One Health Plan PPO/POS |
$310.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$57.89
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$50.14
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$151.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$327.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$303.22
|
| Rate for Payer: Three Rivers Provider Network All |
$258.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$148.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$50.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$151.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$320.85
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$151.61
|
| Rate for Payer: Zelis Auto |
$138.00
|
| Rate for Payer: Zelis Medicare |
$128.87
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$181.93
|
| Rate for Payer: Zelis Worker's Compensation |
$94.19
|
|
|
95886 NEEDLE EMG PERFORMED W/NCV
|
Facility
|
IP
|
$401.00
|
|
|
Service Code
|
CPT 95886
|
| Hospital Charge Code |
21995886
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$109.47 |
| Max. Negotiated Rate |
$380.95 |
| Rate for Payer: Cash Price |
$240.60
|
| Rate for Payer: Cigna Commercial |
$340.85
|
| Rate for Payer: First Health Commercial |
$360.90
|
| Rate for Payer: First Health Workers Compensation |
$154.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$360.90
|
| Rate for Payer: GEHA Commercial |
$280.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$360.90
|
| Rate for Payer: Multiplan All |
$364.91
|
| Rate for Payer: OMNI Networks Commercial |
$280.70
|
| Rate for Payer: One Health Plan PPO/POS |
$360.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$380.95
|
| Rate for Payer: Three Rivers Provider Network All |
$300.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$372.93
|
| Rate for Payer: Zelis Auto |
$160.40
|
| Rate for Payer: Zelis Worker's Compensation |
$109.47
|
|
|
95886 NEEDLE EMG PERFORMED W/NCV
|
Facility
|
OP
|
$401.00
|
|
|
Service Code
|
CPT 95886
|
| Hospital Charge Code |
21900160
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$96.22 |
| Max. Negotiated Rate |
$380.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$121.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$240.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$121.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$96.22
|
| Rate for Payer: Cash Price |
$240.60
|
| Rate for Payer: Cash Price |
$240.60
|
| Rate for Payer: Cigna Commercial |
$340.85
|
| Rate for Payer: First Health Commercial |
$360.90
|
| Rate for Payer: First Health Workers Compensation |
$154.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$360.90
|
| Rate for Payer: GEHA Commercial |
$320.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$360.90
|
| Rate for Payer: Humana ChoiceCare |
$104.26
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$98.18
|
| Rate for Payer: Multiplan All |
$364.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$240.60
|
| Rate for Payer: OMNI Networks Commercial |
$280.70
|
| Rate for Payer: One Health Plan PPO/POS |
$360.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$113.36
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$98.18
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$380.95
|
| Rate for Payer: Three Rivers Provider Network All |
$300.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$352.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$98.18
|
| Rate for Payer: United Payors & United Providers UP&UP |
$372.93
|
| Rate for Payer: Zelis Auto |
$160.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$200.50
|
| Rate for Payer: Zelis Worker's Compensation |
$109.47
|
|
|
95886 NEEDLE EMG PERFORMED W/NCV
|
Facility
|
OP
|
$401.00
|
|
|
Service Code
|
CPT 95886
|
| Hospital Charge Code |
21799451
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$96.22 |
| Max. Negotiated Rate |
$380.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$121.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$240.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$121.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$96.22
|
| Rate for Payer: Cash Price |
$240.60
|
| Rate for Payer: Cash Price |
$240.60
|
| Rate for Payer: Cigna Commercial |
$340.85
|
| Rate for Payer: First Health Commercial |
$360.90
|
| Rate for Payer: First Health Workers Compensation |
$154.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$360.90
|
| Rate for Payer: GEHA Commercial |
$320.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$360.90
|
| Rate for Payer: Humana ChoiceCare |
$104.26
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$98.18
|
| Rate for Payer: Multiplan All |
$364.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$240.60
|
| Rate for Payer: OMNI Networks Commercial |
$280.70
|
| Rate for Payer: One Health Plan PPO/POS |
$360.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$113.36
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$98.18
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$380.95
|
| Rate for Payer: Three Rivers Provider Network All |
$300.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$352.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$98.18
|
| Rate for Payer: United Payors & United Providers UP&UP |
$372.93
|
| Rate for Payer: Zelis Auto |
$160.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$200.50
|
| Rate for Payer: Zelis Worker's Compensation |
$109.47
|
|
