|
95912 NRV CNDJ TEST 11-12 STUDIES
|
Facility
|
IP
|
$770.00
|
|
|
Service Code
|
CPT 95912
|
| Hospital Charge Code |
21700022
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$210.21 |
| Max. Negotiated Rate |
$731.50 |
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Cigna Commercial |
$654.50
|
| Rate for Payer: First Health Commercial |
$693.00
|
| Rate for Payer: First Health Workers Compensation |
$297.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$693.00
|
| Rate for Payer: GEHA Commercial |
$539.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$693.00
|
| Rate for Payer: Multiplan All |
$700.70
|
| Rate for Payer: OMNI Networks Commercial |
$539.00
|
| Rate for Payer: One Health Plan PPO/POS |
$693.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$731.50
|
| Rate for Payer: Three Rivers Provider Network All |
$577.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$716.10
|
| Rate for Payer: Zelis Auto |
$308.00
|
| Rate for Payer: Zelis Worker's Compensation |
$210.21
|
|
|
95912 NRV CNDJ TEST 11-12 STUDIES
|
Facility
|
OP
|
$770.00
|
|
|
Service Code
|
CPT 95912
|
| Hospital Charge Code |
21900131
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$89.67 |
| Max. Negotiated Rate |
$1,007.66 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$113.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$462.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$113.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$89.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$503.83
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Cigna Commercial |
$654.50
|
| Rate for Payer: First Health Commercial |
$693.00
|
| Rate for Payer: First Health Workers Compensation |
$297.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$693.00
|
| Rate for Payer: GEHA Commercial |
$616.00
|
| Rate for Payer: GEHA Medicare |
$503.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$693.00
|
| Rate for Payer: Humana ChoiceCare |
$554.21
|
| Rate for Payer: Humana Medicare Advantage |
$503.83
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$846.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$91.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$503.83
|
| Rate for Payer: Multiplan All |
$700.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$856.51
|
| Rate for Payer: OMNI Networks Commercial |
$539.00
|
| Rate for Payer: One Health Plan PPO/POS |
$693.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$105.64
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$91.50
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$503.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$731.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,007.66
|
| Rate for Payer: Three Rivers Provider Network All |
$577.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$493.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$91.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$503.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$716.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$503.83
|
| Rate for Payer: Zelis Auto |
$308.00
|
| Rate for Payer: Zelis Medicare |
$428.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$604.60
|
| Rate for Payer: Zelis Worker's Compensation |
$210.21
|
|
|
95912 NRV CNDJ TEST 11-12 STUDIES
|
Facility
|
OP
|
$770.00
|
|
|
Service Code
|
CPT 95912
|
| Hospital Charge Code |
21700022
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$89.67 |
| Max. Negotiated Rate |
$1,007.66 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$113.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$462.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$113.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$89.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$503.83
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Cigna Commercial |
$654.50
|
| Rate for Payer: First Health Commercial |
$693.00
|
| Rate for Payer: First Health Workers Compensation |
$297.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$693.00
|
| Rate for Payer: GEHA Commercial |
$616.00
|
| Rate for Payer: GEHA Medicare |
$503.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$693.00
|
| Rate for Payer: Humana ChoiceCare |
$554.21
|
| Rate for Payer: Humana Medicare Advantage |
$503.83
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$846.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$91.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$503.83
|
| Rate for Payer: Multiplan All |
$700.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$856.51
|
| Rate for Payer: OMNI Networks Commercial |
$539.00
|
| Rate for Payer: One Health Plan PPO/POS |
$693.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$105.64
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$91.50
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$503.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$731.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,007.66
|
| Rate for Payer: Three Rivers Provider Network All |
$577.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$493.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$91.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$503.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$716.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$503.83
|
| Rate for Payer: Zelis Auto |
$308.00
|
| Rate for Payer: Zelis Medicare |
$428.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$604.60
|
| Rate for Payer: Zelis Worker's Compensation |
$210.21
|
|
|
95912 NRV CNDJ TEST 11-12 STUDIES
|
Facility
|
IP
|
$770.00
|
|
|
Service Code
|
CPT 95912
|
| Hospital Charge Code |
21900131
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$210.21 |
| Max. Negotiated Rate |
$731.50 |
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Cigna Commercial |
$654.50
|
| Rate for Payer: First Health Commercial |
$693.00
|
| Rate for Payer: First Health Workers Compensation |
$297.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$693.00
|
| Rate for Payer: GEHA Commercial |
$539.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$693.00
|
| Rate for Payer: Multiplan All |
$700.70
|
| Rate for Payer: OMNI Networks Commercial |
$539.00
|
| Rate for Payer: One Health Plan PPO/POS |
$693.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$731.50
|
| Rate for Payer: Three Rivers Provider Network All |
$577.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$716.10
|
| Rate for Payer: Zelis Auto |
$308.00
|
| Rate for Payer: Zelis Worker's Compensation |
$210.21
|
|
|
95913 NRV CNDJ TEST 13/> STUDIES
|
Facility
|
IP
|
$885.00
|
|
|
Service Code
|
CPT 95913
|
| Hospital Charge Code |
21700023
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$241.60 |
| Max. Negotiated Rate |
$840.75 |
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Cigna Commercial |
$752.25
|
| Rate for Payer: First Health Commercial |
$796.50
|
| Rate for Payer: First Health Workers Compensation |
$341.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$796.50
|
| Rate for Payer: GEHA Commercial |
$619.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$796.50
|
| Rate for Payer: Multiplan All |
$805.35
|
| Rate for Payer: OMNI Networks Commercial |
$619.50
|
| Rate for Payer: One Health Plan PPO/POS |
$796.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$840.75
|
| Rate for Payer: Three Rivers Provider Network All |
$663.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$823.05
|
| Rate for Payer: Zelis Auto |
$354.00
|
| Rate for Payer: Zelis Worker's Compensation |
$241.60
|
|
|
95913 NRV CNDJ TEST 13/> STUDIES
|
Facility
|
OP
|
$885.00
|
|
|
Service Code
|
CPT 95913
|
| Hospital Charge Code |
21700023
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$89.67 |
| Max. Negotiated Rate |
$1,007.66 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$113.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$531.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$113.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$89.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$503.83
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Cigna Commercial |
$752.25
|
| Rate for Payer: First Health Commercial |
$796.50
|
| Rate for Payer: First Health Workers Compensation |
$341.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$796.50
|
| Rate for Payer: GEHA Commercial |
$708.00
|
| Rate for Payer: GEHA Medicare |
$503.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$796.50
|
| Rate for Payer: Humana ChoiceCare |
$554.21
|
| Rate for Payer: Humana Medicare Advantage |
$503.83
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$846.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$91.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$503.83
|
| Rate for Payer: Multiplan All |
$805.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$856.51
|
| Rate for Payer: OMNI Networks Commercial |
$619.50
|
| Rate for Payer: One Health Plan PPO/POS |
$796.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$105.64
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$91.50
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$503.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$840.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,007.66
|
| Rate for Payer: Three Rivers Provider Network All |
$663.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$493.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$91.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$503.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$823.05
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$503.83
|
| Rate for Payer: Zelis Auto |
$354.00
|
| Rate for Payer: Zelis Medicare |
$428.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$604.60
|
| Rate for Payer: Zelis Worker's Compensation |
$241.60
|
|
|
95913 NRV CNDJ TEST 13/> STUDIES
|
Facility
|
OP
|
$885.00
|
|
|
Service Code
|
CPT 95913
|
| Hospital Charge Code |
21900132
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$89.67 |
| Max. Negotiated Rate |
$1,007.66 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$113.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$531.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$113.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$89.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$503.83
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Cigna Commercial |
$752.25
|
| Rate for Payer: First Health Commercial |
$796.50
|
| Rate for Payer: First Health Workers Compensation |
$341.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$796.50
|
| Rate for Payer: GEHA Commercial |
$708.00
|
| Rate for Payer: GEHA Medicare |
$503.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$796.50
|
| Rate for Payer: Humana ChoiceCare |
$554.21
|
| Rate for Payer: Humana Medicare Advantage |
$503.83
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$846.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$91.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$503.83
|
| Rate for Payer: Multiplan All |
$805.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$856.51
|
| Rate for Payer: OMNI Networks Commercial |
$619.50
|
| Rate for Payer: One Health Plan PPO/POS |
$796.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$105.64
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$91.50
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$503.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$840.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,007.66
|
| Rate for Payer: Three Rivers Provider Network All |
$663.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$493.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$91.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$503.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$823.05
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$503.83
|
| Rate for Payer: Zelis Auto |
$354.00
|
| Rate for Payer: Zelis Medicare |
$428.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$604.60
|
| Rate for Payer: Zelis Worker's Compensation |
$241.60
|
|
|
95913 NRV CNDJ TEST 13/> STUDIES
|
Facility
|
IP
|
$885.00
|
|
|
Service Code
|
CPT 95913
|
| Hospital Charge Code |
21900132
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$241.60 |
| Max. Negotiated Rate |
$840.75 |
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Cigna Commercial |
$752.25
|
| Rate for Payer: First Health Commercial |
$796.50
|
| Rate for Payer: First Health Workers Compensation |
$341.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$796.50
|
| Rate for Payer: GEHA Commercial |
$619.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$796.50
|
| Rate for Payer: Multiplan All |
$805.35
|
| Rate for Payer: OMNI Networks Commercial |
$619.50
|
| Rate for Payer: One Health Plan PPO/POS |
$796.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$840.75
|
| Rate for Payer: Three Rivers Provider Network All |
$663.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$823.05
|
| Rate for Payer: Zelis Auto |
$354.00
|
| Rate for Payer: Zelis Worker's Compensation |
$241.60
|
|
|
95925 SOMATOSENSORY TESTING
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
CPT 95925
|
| Hospital Charge Code |
21900133
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$591.38 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$271.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$240.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$271.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$214.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$295.69
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$340.00
|
| Rate for Payer: First Health Commercial |
$360.00
|
| Rate for Payer: First Health Workers Compensation |
$154.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$360.00
|
| Rate for Payer: GEHA Commercial |
$320.00
|
| Rate for Payer: GEHA Medicare |
$295.69
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$360.00
|
| 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 |
$219.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$295.69
|
| Rate for Payer: Multiplan All |
$364.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$502.67
|
| Rate for Payer: OMNI Networks Commercial |
$280.00
|
| Rate for Payer: One Health Plan PPO/POS |
$360.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$253.20
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$219.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$295.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$380.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$591.38
|
| Rate for Payer: Three Rivers Provider Network All |
$300.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$289.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$219.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$295.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$372.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$295.69
|
| Rate for Payer: Zelis Auto |
$160.00
|
| Rate for Payer: Zelis Medicare |
$251.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$354.83
|
| Rate for Payer: Zelis Worker's Compensation |
$109.20
|
|
|
95925 SOMATOSENSORY TESTING
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
CPT 95925
|
| Hospital Charge Code |
21700024
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$380.00 |
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$340.00
|
| Rate for Payer: First Health Commercial |
$360.00
|
| Rate for Payer: First Health Workers Compensation |
$154.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$360.00
|
| Rate for Payer: GEHA Commercial |
$280.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$360.00
|
| Rate for Payer: Multiplan All |
$364.00
|
| Rate for Payer: OMNI Networks Commercial |
$280.00
|
| Rate for Payer: One Health Plan PPO/POS |
$360.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$380.00
|
| Rate for Payer: Three Rivers Provider Network All |
$300.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$372.00
|
| Rate for Payer: Zelis Auto |
$160.00
|
| Rate for Payer: Zelis Worker's Compensation |
$109.20
|
|
|
95925 SOMATOSENSORY TESTING
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
CPT 95925
|
| Hospital Charge Code |
21900133
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$380.00 |
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$340.00
|
| Rate for Payer: First Health Commercial |
$360.00
|
| Rate for Payer: First Health Workers Compensation |
$154.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$360.00
|
| Rate for Payer: GEHA Commercial |
$280.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$360.00
|
| Rate for Payer: Multiplan All |
$364.00
|
| Rate for Payer: OMNI Networks Commercial |
$280.00
|
| Rate for Payer: One Health Plan PPO/POS |
$360.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$380.00
|
| Rate for Payer: Three Rivers Provider Network All |
$300.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$372.00
|
| Rate for Payer: Zelis Auto |
$160.00
|
| Rate for Payer: Zelis Worker's Compensation |
$109.20
|
|
|
95925 SOMATOSENSORY TESTING
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
CPT 95925
|
| Hospital Charge Code |
21700024
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$591.38 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$271.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$240.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$271.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$214.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$295.69
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$340.00
|
| Rate for Payer: First Health Commercial |
$360.00
|
| Rate for Payer: First Health Workers Compensation |
$154.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$360.00
|
| Rate for Payer: GEHA Commercial |
$320.00
|
| Rate for Payer: GEHA Medicare |
$295.69
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$360.00
|
| 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 |
$219.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$295.69
|
| Rate for Payer: Multiplan All |
$364.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$502.67
|
| Rate for Payer: OMNI Networks Commercial |
$280.00
|
| Rate for Payer: One Health Plan PPO/POS |
$360.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$253.20
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$219.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$295.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$380.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$591.38
|
| Rate for Payer: Three Rivers Provider Network All |
$300.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$289.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$219.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$295.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$372.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$295.69
|
| Rate for Payer: Zelis Auto |
$160.00
|
| Rate for Payer: Zelis Medicare |
$251.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$354.83
|
| Rate for Payer: Zelis Worker's Compensation |
$109.20
|
|
|
95926 SOMATOSENSORY IN LOWER LIMB
|
Facility
|
IP
|
$371.00
|
|
|
Service Code
|
CPT 95926
|
| Hospital Charge Code |
21795926
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$101.28 |
| Max. Negotiated Rate |
$352.45 |
| Rate for Payer: Cash Price |
$222.60
|
| Rate for Payer: Cigna Commercial |
$315.35
|
| Rate for Payer: First Health Commercial |
$333.90
|
| Rate for Payer: First Health Workers Compensation |
$143.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$333.90
|
| Rate for Payer: GEHA Commercial |
$259.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$333.90
|
| Rate for Payer: Multiplan All |
$337.61
|
| Rate for Payer: OMNI Networks Commercial |
$259.70
|
| Rate for Payer: One Health Plan PPO/POS |
$333.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$352.45
|
| Rate for Payer: Three Rivers Provider Network All |
$278.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$345.03
|
| Rate for Payer: Zelis Auto |
$148.40
|
| Rate for Payer: Zelis Worker's Compensation |
$101.28
|
|
|
95926 SOMATOSENSORY IN LOWER LIMB
|
Facility
|
IP
|
$371.00
|
|
|
Service Code
|
CPT 95926
|
| Hospital Charge Code |
21900162
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$101.28 |
| Max. Negotiated Rate |
$352.45 |
| Rate for Payer: Cash Price |
$222.60
|
| Rate for Payer: Cigna Commercial |
$315.35
|
| Rate for Payer: First Health Commercial |
$333.90
|
| Rate for Payer: First Health Workers Compensation |
$143.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$333.90
|
| Rate for Payer: GEHA Commercial |
$259.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$333.90
|
| Rate for Payer: Multiplan All |
$337.61
|
| Rate for Payer: OMNI Networks Commercial |
$259.70
|
| Rate for Payer: One Health Plan PPO/POS |
$333.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$352.45
|
| Rate for Payer: Three Rivers Provider Network All |
$278.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$345.03
|
| Rate for Payer: Zelis Auto |
$148.40
|
| Rate for Payer: Zelis Worker's Compensation |
$101.28
|
|
|
95926 SOMATOSENSORY IN LOWER LIMB
|
Facility
|
OP
|
$371.00
|
|
|
Service Code
|
CPT 95926
|
| Hospital Charge Code |
21795926
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$101.28 |
| Max. Negotiated Rate |
$591.38 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$271.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$222.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$271.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$214.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$295.69
|
| Rate for Payer: Cash Price |
$222.60
|
| Rate for Payer: Cash Price |
$222.60
|
| Rate for Payer: Cigna Commercial |
$315.35
|
| Rate for Payer: First Health Commercial |
$333.90
|
| Rate for Payer: First Health Workers Compensation |
$143.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$333.90
|
| Rate for Payer: GEHA Commercial |
$296.80
|
| Rate for Payer: GEHA Medicare |
$295.69
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$333.90
|
| 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 |
$219.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$295.69
|
| Rate for Payer: Multiplan All |
$337.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$502.67
|
| Rate for Payer: OMNI Networks Commercial |
$259.70
|
| Rate for Payer: One Health Plan PPO/POS |
$333.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$253.20
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$219.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$295.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$352.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$591.38
|
| Rate for Payer: Three Rivers Provider Network All |
$278.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$289.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$219.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$295.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$345.03
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$295.69
|
| Rate for Payer: Zelis Auto |
$148.40
|
| Rate for Payer: Zelis Medicare |
$251.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$354.83
|
| Rate for Payer: Zelis Worker's Compensation |
$101.28
|
|
|
95926 SOMATOSENSORY IN LOWER LIMB
|
Facility
|
OP
|
$371.00
|
|
|
Service Code
|
CPT 95926
|
| Hospital Charge Code |
21900162
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$101.28 |
| Max. Negotiated Rate |
$591.38 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$271.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$222.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$271.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$214.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$295.69
|
| Rate for Payer: Cash Price |
$222.60
|
| Rate for Payer: Cash Price |
$222.60
|
| Rate for Payer: Cigna Commercial |
$315.35
|
| Rate for Payer: First Health Commercial |
$333.90
|
| Rate for Payer: First Health Workers Compensation |
$143.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$333.90
|
| Rate for Payer: GEHA Commercial |
$296.80
|
| Rate for Payer: GEHA Medicare |
$295.69
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$333.90
|
| 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 |
$219.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$295.69
|
| Rate for Payer: Multiplan All |
$337.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$502.67
|
| Rate for Payer: OMNI Networks Commercial |
$259.70
|
| Rate for Payer: One Health Plan PPO/POS |
$333.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$253.20
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$219.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$295.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$352.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$591.38
|
| Rate for Payer: Three Rivers Provider Network All |
$278.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$289.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$219.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$295.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$345.03
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$295.69
|
| Rate for Payer: Zelis Auto |
$148.40
|
| Rate for Payer: Zelis Medicare |
$251.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$354.83
|
| Rate for Payer: Zelis Worker's Compensation |
$101.28
|
|
|
95927 SOMATOSESORY IN TRUNK OR HEA
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 95927
|
| Hospital Charge Code |
21795927
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$47.23 |
| Max. Negotiated Rate |
$591.38 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$271.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$103.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$271.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$214.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$295.69
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$66.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$138.40
|
| Rate for Payer: GEHA Medicare |
$295.69
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| 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 |
$219.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$295.69
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$502.67
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$253.20
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$219.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$295.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$591.38
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$289.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$219.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$295.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$295.69
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Medicare |
$251.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$354.83
|
| Rate for Payer: Zelis Worker's Compensation |
$47.23
|
|
|
95927 SOMATOSESORY IN TRUNK OR HEA
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 95927
|
| Hospital Charge Code |
21900163
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$47.23 |
| Max. Negotiated Rate |
$591.38 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$271.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$103.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$271.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$214.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$295.69
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$66.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$138.40
|
| Rate for Payer: GEHA Medicare |
$295.69
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| 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 |
$219.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$295.69
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$502.67
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$253.20
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$219.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$295.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$591.38
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$289.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$219.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$295.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$295.69
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Medicare |
$251.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$354.83
|
| Rate for Payer: Zelis Worker's Compensation |
$47.23
|
|
|
95927 SOMATOSESORY IN TRUNK OR HEA
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 95927
|
| Hospital Charge Code |
21900163
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$47.23 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$66.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$121.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Worker's Compensation |
$47.23
|
|
|
95927 SOMATOSESORY IN TRUNK OR HEA
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 95927
|
| Hospital Charge Code |
21795927
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$47.23 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$66.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$121.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Worker's Compensation |
$47.23
|
|
|
95930 VISUAL EVOKED POTENTIAL TEST
|
Facility
|
IP
|
$371.00
|
|
|
Service Code
|
CPT 95930
|
| Hospital Charge Code |
21900134
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$101.28 |
| Max. Negotiated Rate |
$352.45 |
| Rate for Payer: Cash Price |
$222.60
|
| Rate for Payer: Cigna Commercial |
$315.35
|
| Rate for Payer: First Health Commercial |
$333.90
|
| Rate for Payer: First Health Workers Compensation |
$143.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$333.90
|
| Rate for Payer: GEHA Commercial |
$259.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$333.90
|
| Rate for Payer: Multiplan All |
$337.61
|
| Rate for Payer: OMNI Networks Commercial |
$259.70
|
| Rate for Payer: One Health Plan PPO/POS |
$333.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$352.45
|
| Rate for Payer: Three Rivers Provider Network All |
$278.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$345.03
|
| Rate for Payer: Zelis Auto |
$148.40
|
| Rate for Payer: Zelis Worker's Compensation |
$101.28
|
|
|
95930 VISUAL EVOKED POTENTIAL TEST
|
Facility
|
IP
|
$371.00
|
|
|
Service Code
|
CPT 95930
|
| Hospital Charge Code |
21700025
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$101.28 |
| Max. Negotiated Rate |
$352.45 |
| Rate for Payer: Cash Price |
$222.60
|
| Rate for Payer: Cigna Commercial |
$315.35
|
| Rate for Payer: First Health Commercial |
$333.90
|
| Rate for Payer: First Health Workers Compensation |
$143.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$333.90
|
| Rate for Payer: GEHA Commercial |
$259.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$333.90
|
| Rate for Payer: Multiplan All |
$337.61
|
| Rate for Payer: OMNI Networks Commercial |
$259.70
|
| Rate for Payer: One Health Plan PPO/POS |
$333.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$352.45
|
| Rate for Payer: Three Rivers Provider Network All |
$278.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$345.03
|
| Rate for Payer: Zelis Auto |
$148.40
|
| Rate for Payer: Zelis Worker's Compensation |
$101.28
|
|
|
95930 VISUAL EVOKED POTENTIAL TEST
|
Facility
|
OP
|
$371.00
|
|
|
Service Code
|
CPT 95930
|
| Hospital Charge Code |
21700025
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$101.28 |
| Max. Negotiated Rate |
$591.38 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$271.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$222.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$271.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$214.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$295.69
|
| Rate for Payer: Cash Price |
$222.60
|
| Rate for Payer: Cash Price |
$222.60
|
| Rate for Payer: Cigna Commercial |
$315.35
|
| Rate for Payer: First Health Commercial |
$333.90
|
| Rate for Payer: First Health Workers Compensation |
$143.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$333.90
|
| Rate for Payer: GEHA Commercial |
$296.80
|
| Rate for Payer: GEHA Medicare |
$295.69
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$333.90
|
| 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 |
$219.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$295.69
|
| Rate for Payer: Multiplan All |
$337.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$502.67
|
| Rate for Payer: OMNI Networks Commercial |
$259.70
|
| Rate for Payer: One Health Plan PPO/POS |
$333.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$253.20
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$219.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$295.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$352.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$591.38
|
| Rate for Payer: Three Rivers Provider Network All |
$278.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$289.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$219.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$295.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$345.03
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$295.69
|
| Rate for Payer: Zelis Auto |
$148.40
|
| Rate for Payer: Zelis Medicare |
$251.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$354.83
|
| Rate for Payer: Zelis Worker's Compensation |
$101.28
|
|
|
95930 VISUAL EVOKED POTENTIAL TEST
|
Facility
|
OP
|
$371.00
|
|
|
Service Code
|
CPT 95930
|
| Hospital Charge Code |
21900134
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$101.28 |
| Max. Negotiated Rate |
$591.38 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$271.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$222.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$271.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$214.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$295.69
|
| Rate for Payer: Cash Price |
$222.60
|
| Rate for Payer: Cash Price |
$222.60
|
| Rate for Payer: Cigna Commercial |
$315.35
|
| Rate for Payer: First Health Commercial |
$333.90
|
| Rate for Payer: First Health Workers Compensation |
$143.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$333.90
|
| Rate for Payer: GEHA Commercial |
$296.80
|
| Rate for Payer: GEHA Medicare |
$295.69
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$333.90
|
| 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 |
$219.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$295.69
|
| Rate for Payer: Multiplan All |
$337.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$502.67
|
| Rate for Payer: OMNI Networks Commercial |
$259.70
|
| Rate for Payer: One Health Plan PPO/POS |
$333.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$253.20
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$219.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$295.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$352.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$591.38
|
| Rate for Payer: Three Rivers Provider Network All |
$278.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$289.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$219.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$295.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$345.03
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$295.69
|
| Rate for Payer: Zelis Auto |
$148.40
|
| Rate for Payer: Zelis Medicare |
$251.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$354.83
|
| Rate for Payer: Zelis Worker's Compensation |
$101.28
|
|
|
95933 BLINK REFLEX TEST
|
Facility
|
IP
|
$224.00
|
|
|
Service Code
|
CPT 95933
|
| Hospital Charge Code |
21700026
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$61.15 |
| Max. Negotiated Rate |
$212.80 |
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cigna Commercial |
$190.40
|
| Rate for Payer: First Health Commercial |
$201.60
|
| Rate for Payer: First Health Workers Compensation |
$86.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$201.60
|
| Rate for Payer: GEHA Commercial |
$156.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$201.60
|
| Rate for Payer: Multiplan All |
$203.84
|
| Rate for Payer: OMNI Networks Commercial |
$156.80
|
| Rate for Payer: One Health Plan PPO/POS |
$201.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$212.80
|
| Rate for Payer: Three Rivers Provider Network All |
$168.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$208.32
|
| Rate for Payer: Zelis Auto |
$89.60
|
| Rate for Payer: Zelis Worker's Compensation |
$61.15
|
|
