|
95933 BLINK REFLEX TEST
|
Facility
|
OP
|
$224.00
|
|
|
Service Code
|
CPT 95933
|
| Hospital Charge Code |
21700026
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$47.94 |
| Max. Negotiated Rate |
$212.80 |
| 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 |
$134.40
|
| 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 |
$56.40
|
| Rate for Payer: Cash Price |
$134.40
|
| 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 |
$179.20
|
| Rate for Payer: GEHA Medicare |
$56.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$201.60
|
| Rate for Payer: Humana ChoiceCare |
$62.04
|
| Rate for Payer: Humana Medicare Advantage |
$56.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$94.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$115.10
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$56.40
|
| Rate for Payer: Multiplan All |
$203.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$95.88
|
| Rate for Payer: OMNI Networks Commercial |
$156.80
|
| Rate for Payer: One Health Plan PPO/POS |
$201.60
|
| 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 |
$56.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$212.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$112.80
|
| Rate for Payer: Three Rivers Provider Network All |
$168.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$55.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$208.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$56.40
|
| Rate for Payer: Zelis Auto |
$89.60
|
| Rate for Payer: Zelis Medicare |
$47.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$67.68
|
| Rate for Payer: Zelis Worker's Compensation |
$61.15
|
|
|
95933 BLINK REFLEX TEST
|
Facility
|
OP
|
$224.00
|
|
|
Service Code
|
CPT 95933
|
| Hospital Charge Code |
21900135
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$47.94 |
| Max. Negotiated Rate |
$212.80 |
| 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 |
$134.40
|
| 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 |
$56.40
|
| Rate for Payer: Cash Price |
$134.40
|
| 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 |
$179.20
|
| Rate for Payer: GEHA Medicare |
$56.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$201.60
|
| Rate for Payer: Humana ChoiceCare |
$62.04
|
| Rate for Payer: Humana Medicare Advantage |
$56.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$94.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$115.10
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$56.40
|
| Rate for Payer: Multiplan All |
$203.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$95.88
|
| Rate for Payer: OMNI Networks Commercial |
$156.80
|
| Rate for Payer: One Health Plan PPO/POS |
$201.60
|
| 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 |
$56.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$212.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$112.80
|
| Rate for Payer: Three Rivers Provider Network All |
$168.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$55.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$208.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$56.40
|
| Rate for Payer: Zelis Auto |
$89.60
|
| Rate for Payer: Zelis Medicare |
$47.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$67.68
|
| Rate for Payer: Zelis Worker's Compensation |
$61.15
|
|
|
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
|
|
|
95937 NEUROMUSCULAR JUNCTION TEST
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
CPT 95937
|
| Hospital Charge Code |
21700027
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$65.52 |
| Max. Negotiated Rate |
$297.14 |
| 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 |
$144.00
|
| 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 |
$148.57
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$204.00
|
| Rate for Payer: First Health Commercial |
$216.00
|
| Rate for Payer: First Health Workers Compensation |
$92.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$216.00
|
| Rate for Payer: GEHA Commercial |
$192.00
|
| Rate for Payer: GEHA Medicare |
$148.57
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$216.00
|
| Rate for Payer: Humana ChoiceCare |
$163.43
|
| Rate for Payer: Humana Medicare Advantage |
$148.57
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$249.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$97.79
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$148.57
|
| Rate for Payer: Multiplan All |
$218.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$252.57
|
| Rate for Payer: OMNI Networks Commercial |
$168.00
|
| Rate for Payer: One Health Plan PPO/POS |
$216.00
|
| 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 |
$148.57
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$228.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$297.14
|
| Rate for Payer: Three Rivers Provider Network All |
$180.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$145.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$97.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$148.57
|
| Rate for Payer: United Payors & United Providers UP&UP |
$223.20
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$148.57
|
| Rate for Payer: Zelis Auto |
$96.00
|
| Rate for Payer: Zelis Medicare |
$126.28
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$178.28
|
| Rate for Payer: Zelis Worker's Compensation |
$65.52
|
|
|
95937 NEUROMUSCULAR JUNCTION TEST
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
CPT 95937
|
| Hospital Charge Code |
21900136
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$65.79 |
| Max. Negotiated Rate |
$297.14 |
| 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 |
$144.60
|
| 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 |
$148.57
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cigna Commercial |
$204.85
|
| Rate for Payer: First Health Commercial |
$216.90
|
| Rate for Payer: First Health Workers Compensation |
$93.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$216.90
|
| Rate for Payer: GEHA Commercial |
$192.80
|
| Rate for Payer: GEHA Medicare |
$148.57
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$216.90
|
| Rate for Payer: Humana ChoiceCare |
$163.43
|
| Rate for Payer: Humana Medicare Advantage |
$148.57
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$249.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$97.79
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$148.57
|
| Rate for Payer: Multiplan All |
$219.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$252.57
|
| Rate for Payer: OMNI Networks Commercial |
$168.70
|
| Rate for Payer: One Health Plan PPO/POS |
$216.90
|
| 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 |
$148.57
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$228.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$297.14
|
| Rate for Payer: Three Rivers Provider Network All |
$180.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$145.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$97.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$148.57
|
| Rate for Payer: United Payors & United Providers UP&UP |
$224.13
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$148.57
|
| Rate for Payer: Zelis Auto |
$96.40
|
| Rate for Payer: Zelis Medicare |
$126.28
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$178.28
|
| Rate for Payer: Zelis Worker's Compensation |
$65.79
|
|
|
95937 NEUROMUSCULAR JUNCTION TEST
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
CPT 95937
|
| Hospital Charge Code |
21900136
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$65.79 |
| Max. Negotiated Rate |
$228.95 |
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cigna Commercial |
$204.85
|
| Rate for Payer: First Health Commercial |
$216.90
|
| Rate for Payer: First Health Workers Compensation |
$93.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$216.90
|
| Rate for Payer: GEHA Commercial |
$168.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$216.90
|
| Rate for Payer: Multiplan All |
$219.31
|
| Rate for Payer: OMNI Networks Commercial |
$168.70
|
| Rate for Payer: One Health Plan PPO/POS |
$216.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$228.95
|
| Rate for Payer: Three Rivers Provider Network All |
$180.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$224.13
|
| Rate for Payer: Zelis Auto |
$96.40
|
| Rate for Payer: Zelis Worker's Compensation |
$65.79
|
|
|
95937 NEUROMUSCULAR JUNCTION TEST
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
CPT 95937
|
| Hospital Charge Code |
21700027
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$65.52 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$204.00
|
| Rate for Payer: First Health Commercial |
$216.00
|
| Rate for Payer: First Health Workers Compensation |
$92.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$216.00
|
| Rate for Payer: GEHA Commercial |
$168.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$216.00
|
| Rate for Payer: Multiplan All |
$218.40
|
| Rate for Payer: OMNI Networks Commercial |
$168.00
|
| Rate for Payer: One Health Plan PPO/POS |
$216.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$228.00
|
| Rate for Payer: Three Rivers Provider Network All |
$180.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$223.20
|
| Rate for Payer: Zelis Auto |
$96.00
|
| Rate for Payer: Zelis Worker's Compensation |
$65.52
|
|
|
95951 EEG MONITORING/VIDEORECORD
|
Facility
|
IP
|
$979.00
|
|
|
Service Code
|
CPT 95951
|
| Hospital Charge Code |
21700028
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$267.27 |
| Max. Negotiated Rate |
$930.05 |
| Rate for Payer: Cash Price |
$587.40
|
| Rate for Payer: Cigna Commercial |
$832.15
|
| Rate for Payer: First Health Commercial |
$881.10
|
| Rate for Payer: First Health Workers Compensation |
$377.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$881.10
|
| Rate for Payer: GEHA Commercial |
$685.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$881.10
|
| Rate for Payer: Multiplan All |
$890.89
|
| Rate for Payer: OMNI Networks Commercial |
$685.30
|
| Rate for Payer: One Health Plan PPO/POS |
$881.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$930.05
|
| Rate for Payer: Three Rivers Provider Network All |
$734.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$910.47
|
| Rate for Payer: Zelis Auto |
$391.60
|
| Rate for Payer: Zelis Worker's Compensation |
$267.27
|
|
|
95951 EEG MONITORING/VIDEORECORD
|
Facility
|
IP
|
$979.00
|
|
|
Service Code
|
CPT 95951
|
| Hospital Charge Code |
21900137
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$267.27 |
| Max. Negotiated Rate |
$930.05 |
| Rate for Payer: Cash Price |
$587.40
|
| Rate for Payer: Cigna Commercial |
$832.15
|
| Rate for Payer: First Health Commercial |
$881.10
|
| Rate for Payer: First Health Workers Compensation |
$377.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$881.10
|
| Rate for Payer: GEHA Commercial |
$685.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$881.10
|
| Rate for Payer: Multiplan All |
$890.89
|
| Rate for Payer: OMNI Networks Commercial |
$685.30
|
| Rate for Payer: One Health Plan PPO/POS |
$881.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$930.05
|
| Rate for Payer: Three Rivers Provider Network All |
$734.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$910.47
|
| Rate for Payer: Zelis Auto |
$391.60
|
| Rate for Payer: Zelis Worker's Compensation |
$267.27
|
|
|
95951 EEG MONITORING/VIDEORECORD
|
Facility
|
OP
|
$979.00
|
|
|
Service Code
|
CPT 95951
|
| Hospital Charge Code |
21700028
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$244.75 |
| Max. Negotiated Rate |
$930.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$587.40
|
| Rate for Payer: Cash Price |
$587.40
|
| Rate for Payer: Cigna Commercial |
$832.15
|
| Rate for Payer: First Health Commercial |
$881.10
|
| Rate for Payer: First Health Workers Compensation |
$377.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$881.10
|
| Rate for Payer: GEHA Commercial |
$783.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$881.10
|
| Rate for Payer: Humana ChoiceCare |
$254.54
|
| Rate for Payer: Multiplan All |
$890.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$587.40
|
| Rate for Payer: OMNI Networks Commercial |
$685.30
|
| Rate for Payer: One Health Plan PPO/POS |
$881.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$930.05
|
| Rate for Payer: Three Rivers Provider Network All |
$734.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$861.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$244.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$910.47
|
| Rate for Payer: Zelis Auto |
$391.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$489.50
|
| Rate for Payer: Zelis Worker's Compensation |
$267.27
|
|
|
95951 EEG MONITORING/VIDEORECORD
|
Facility
|
OP
|
$979.00
|
|
|
Service Code
|
CPT 95951
|
| Hospital Charge Code |
21900137
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$244.75 |
| Max. Negotiated Rate |
$930.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$587.40
|
| Rate for Payer: Cash Price |
$587.40
|
| Rate for Payer: Cigna Commercial |
$832.15
|
| Rate for Payer: First Health Commercial |
$881.10
|
| Rate for Payer: First Health Workers Compensation |
$377.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$881.10
|
| Rate for Payer: GEHA Commercial |
$783.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$881.10
|
| Rate for Payer: Humana ChoiceCare |
$254.54
|
| Rate for Payer: Multiplan All |
$890.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$587.40
|
| Rate for Payer: OMNI Networks Commercial |
$685.30
|
| Rate for Payer: One Health Plan PPO/POS |
$881.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$930.05
|
| Rate for Payer: Three Rivers Provider Network All |
$734.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$861.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$244.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$910.47
|
| Rate for Payer: Zelis Auto |
$391.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$489.50
|
| Rate for Payer: Zelis Worker's Compensation |
$267.27
|
|
|
95953 EEG MONITORING/COMPUTE
|
Facility
|
IP
|
$467.00
|
|
|
Service Code
|
CPT 95953
|
| Hospital Charge Code |
21900164
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$127.49 |
| Max. Negotiated Rate |
$443.65 |
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cigna Commercial |
$396.95
|
| Rate for Payer: First Health Commercial |
$420.30
|
| Rate for Payer: First Health Workers Compensation |
$180.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$420.30
|
| Rate for Payer: GEHA Commercial |
$326.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$420.30
|
| Rate for Payer: Multiplan All |
$424.97
|
| Rate for Payer: OMNI Networks Commercial |
$326.90
|
| Rate for Payer: One Health Plan PPO/POS |
$420.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$443.65
|
| Rate for Payer: Three Rivers Provider Network All |
$350.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$434.31
|
| Rate for Payer: Zelis Auto |
$186.80
|
| Rate for Payer: Zelis Worker's Compensation |
$127.49
|
|
|
95953 EEG MONITORING/COMPUTE
|
Facility
|
OP
|
$467.00
|
|
|
Service Code
|
CPT 95953
|
| Hospital Charge Code |
21900164
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$116.75 |
| Max. Negotiated Rate |
$443.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$280.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cigna Commercial |
$396.95
|
| Rate for Payer: First Health Commercial |
$420.30
|
| Rate for Payer: First Health Workers Compensation |
$180.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$420.30
|
| Rate for Payer: GEHA Commercial |
$373.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$420.30
|
| Rate for Payer: Humana ChoiceCare |
$121.42
|
| Rate for Payer: Multiplan All |
$424.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$280.20
|
| Rate for Payer: OMNI Networks Commercial |
$326.90
|
| Rate for Payer: One Health Plan PPO/POS |
$420.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$443.65
|
| Rate for Payer: Three Rivers Provider Network All |
$350.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$410.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$116.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$434.31
|
| Rate for Payer: Zelis Auto |
$186.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$233.50
|
| Rate for Payer: Zelis Worker's Compensation |
$127.49
|
|
|
95953 EEG MONITORING/COMPUTE
|
Facility
|
OP
|
$467.00
|
|
|
Service Code
|
CPT 95953
|
| Hospital Charge Code |
21795953
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$116.75 |
| Max. Negotiated Rate |
$443.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$280.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cigna Commercial |
$396.95
|
| Rate for Payer: First Health Commercial |
$420.30
|
| Rate for Payer: First Health Workers Compensation |
$180.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$420.30
|
| Rate for Payer: GEHA Commercial |
$373.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$420.30
|
| Rate for Payer: Humana ChoiceCare |
$121.42
|
| Rate for Payer: Multiplan All |
$424.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$280.20
|
| Rate for Payer: OMNI Networks Commercial |
$326.90
|
| Rate for Payer: One Health Plan PPO/POS |
$420.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$443.65
|
| Rate for Payer: Three Rivers Provider Network All |
$350.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$410.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$116.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$434.31
|
| Rate for Payer: Zelis Auto |
$186.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$233.50
|
| Rate for Payer: Zelis Worker's Compensation |
$127.49
|
|
|
95953 EEG MONITORING/COMPUTE
|
Facility
|
IP
|
$467.00
|
|
|
Service Code
|
CPT 95953
|
| Hospital Charge Code |
21795953
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$127.49 |
| Max. Negotiated Rate |
$443.65 |
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cigna Commercial |
$396.95
|
| Rate for Payer: First Health Commercial |
$420.30
|
| Rate for Payer: First Health Workers Compensation |
$180.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$420.30
|
| Rate for Payer: GEHA Commercial |
$326.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$420.30
|
| Rate for Payer: Multiplan All |
$424.97
|
| Rate for Payer: OMNI Networks Commercial |
$326.90
|
| Rate for Payer: One Health Plan PPO/POS |
$420.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$443.65
|
| Rate for Payer: Three Rivers Provider Network All |
$350.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$434.31
|
| Rate for Payer: Zelis Auto |
$186.80
|
| Rate for Payer: Zelis Worker's Compensation |
$127.49
|
|
|
95970 ELE ALY IMPL NPG PHYS/QHP W/O PROG
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
CPT 95970
|
| Hospital Charge Code |
21795970
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$102.38 |
| Max. Negotiated Rate |
$356.25 |
| 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 |
$225.00
|
| 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 |
$122.40
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$318.75
|
| Rate for Payer: First Health Commercial |
$337.50
|
| Rate for Payer: First Health Workers Compensation |
$144.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$337.50
|
| Rate for Payer: GEHA Commercial |
$300.00
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$337.50
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$115.10
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$341.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$262.50
|
| Rate for Payer: One Health Plan PPO/POS |
$337.50
|
| 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 |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$356.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$281.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$348.75
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$150.00
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$102.38
|
|
|
95970 ELE ALY IMPL NPG PHYS/QHP W/O PROG
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
CPT 95970
|
| Hospital Charge Code |
21795970
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$102.38 |
| Max. Negotiated Rate |
$356.25 |
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$318.75
|
| Rate for Payer: First Health Commercial |
$337.50
|
| Rate for Payer: First Health Workers Compensation |
$144.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$337.50
|
| Rate for Payer: GEHA Commercial |
$262.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$337.50
|
| Rate for Payer: Multiplan All |
$341.25
|
| Rate for Payer: OMNI Networks Commercial |
$262.50
|
| Rate for Payer: One Health Plan PPO/POS |
$337.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$356.25
|
| Rate for Payer: Three Rivers Provider Network All |
$281.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$348.75
|
| Rate for Payer: Zelis Auto |
$150.00
|
| Rate for Payer: Zelis Worker's Compensation |
$102.38
|
|
|
95976ELEC ALYS IMPLT SMPL CN NPGT PRGRMG
|
Facility
|
OP
|
$415.00
|
|
|
Service Code
|
CPT 95976
|
| Hospital Charge Code |
21795976
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.10 |
| Max. Negotiated Rate |
$394.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$55.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$249.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$55.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$44.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$35.41
|
| Rate for Payer: Cash Price |
$249.00
|
| Rate for Payer: Cash Price |
$249.00
|
| Rate for Payer: Cigna Commercial |
$352.75
|
| Rate for Payer: First Health Commercial |
$373.50
|
| Rate for Payer: First Health Workers Compensation |
$160.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$373.50
|
| Rate for Payer: GEHA Commercial |
$332.00
|
| Rate for Payer: GEHA Medicare |
$35.41
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$373.50
|
| Rate for Payer: Humana ChoiceCare |
$38.95
|
| Rate for Payer: Humana Medicare Advantage |
$35.41
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$59.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$45.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$35.41
|
| Rate for Payer: Multiplan All |
$377.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$60.20
|
| Rate for Payer: OMNI Networks Commercial |
$290.50
|
| Rate for Payer: One Health Plan PPO/POS |
$373.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$52.02
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$45.06
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$35.41
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$394.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$70.82
|
| Rate for Payer: Three Rivers Provider Network All |
$311.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$34.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$45.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.41
|
| Rate for Payer: United Payors & United Providers UP&UP |
$385.95
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$35.41
|
| Rate for Payer: Zelis Auto |
$166.00
|
| Rate for Payer: Zelis Medicare |
$30.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$42.49
|
| Rate for Payer: Zelis Worker's Compensation |
$113.30
|
|
|
95976ELEC ALYS IMPLT SMPL CN NPGT PRGRMG
|
Facility
|
IP
|
$415.00
|
|
|
Service Code
|
CPT 95976
|
| Hospital Charge Code |
21795976
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$113.30 |
| Max. Negotiated Rate |
$394.25 |
| Rate for Payer: Cash Price |
$249.00
|
| Rate for Payer: Cigna Commercial |
$352.75
|
| Rate for Payer: First Health Commercial |
$373.50
|
| Rate for Payer: First Health Workers Compensation |
$160.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$373.50
|
| Rate for Payer: GEHA Commercial |
$290.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$373.50
|
| Rate for Payer: Multiplan All |
$377.65
|
| Rate for Payer: OMNI Networks Commercial |
$290.50
|
| Rate for Payer: One Health Plan PPO/POS |
$373.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$394.25
|
| Rate for Payer: Three Rivers Provider Network All |
$311.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$385.95
|
| Rate for Payer: Zelis Auto |
$166.00
|
| Rate for Payer: Zelis Worker's Compensation |
$113.30
|
|
|
95977ELEC ALYS IMPLT CPLX CN NPGT PRGRMG
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
CPT 95977
|
| Hospital Charge Code |
21799446
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.05 |
| Max. Negotiated Rate |
$176.31 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$176.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$99.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$176.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$139.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$87.16
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$140.25
|
| Rate for Payer: First Health Commercial |
$148.50
|
| Rate for Payer: First Health Workers Compensation |
$63.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$148.50
|
| Rate for Payer: GEHA Commercial |
$132.00
|
| Rate for Payer: GEHA Medicare |
$87.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$148.50
|
| Rate for Payer: Humana ChoiceCare |
$95.88
|
| Rate for Payer: Humana Medicare Advantage |
$87.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$146.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$142.52
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$87.16
|
| Rate for Payer: Multiplan All |
$150.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$148.17
|
| Rate for Payer: OMNI Networks Commercial |
$115.50
|
| Rate for Payer: One Health Plan PPO/POS |
$148.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$164.56
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$142.52
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$87.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$156.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$174.32
|
| Rate for Payer: Three Rivers Provider Network All |
$123.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$85.42
|
| Rate for Payer: United Healthcare Managed Medicaid |
$142.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$87.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$153.45
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$87.16
|
| Rate for Payer: Zelis Auto |
$66.00
|
| Rate for Payer: Zelis Medicare |
$74.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$104.59
|
| Rate for Payer: Zelis Worker's Compensation |
$45.05
|
|
|
95977ELEC ALYS IMPLT CPLX CN NPGT PRGRMG
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
CPT 95977
|
| Hospital Charge Code |
21799446
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.05 |
| Max. Negotiated Rate |
$156.75 |
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$140.25
|
| Rate for Payer: First Health Commercial |
$148.50
|
| Rate for Payer: First Health Workers Compensation |
$63.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$148.50
|
| Rate for Payer: GEHA Commercial |
$115.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$148.50
|
| Rate for Payer: Multiplan All |
$150.15
|
| Rate for Payer: OMNI Networks Commercial |
$115.50
|
| Rate for Payer: One Health Plan PPO/POS |
$148.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$156.75
|
| Rate for Payer: Three Rivers Provider Network All |
$123.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$153.45
|
| Rate for Payer: Zelis Auto |
$66.00
|
| Rate for Payer: Zelis Worker's Compensation |
$45.05
|
|
|
95992 CANALITH REPOSITIONING PROCEDURE
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT 95992
|
| Hospital Charge Code |
21795992
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.32 |
| Max. Negotiated Rate |
$142.40 |
| 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 |
$79.20
|
| 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: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cigna Commercial |
$112.20
|
| Rate for Payer: First Health Commercial |
$118.80
|
| Rate for Payer: First Health Workers Compensation |
$50.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$118.80
|
| Rate for Payer: GEHA Commercial |
$105.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$118.80
|
| Rate for Payer: Humana ChoiceCare |
$34.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$115.10
|
| Rate for Payer: Multiplan All |
$120.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$79.20
|
| Rate for Payer: OMNI Networks Commercial |
$92.40
|
| Rate for Payer: One Health Plan PPO/POS |
$118.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$132.90
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$115.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$125.40
|
| Rate for Payer: Three Rivers Provider Network All |
$99.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$116.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$122.76
|
| Rate for Payer: Zelis Auto |
$52.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$66.00
|
| Rate for Payer: Zelis Worker's Compensation |
$36.04
|
|
|
95992 CANALITH REPOSITIONING PROCEDURE
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT 95992
|
| Hospital Charge Code |
21795992
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$36.04 |
| Max. Negotiated Rate |
$125.40 |
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cigna Commercial |
$112.20
|
| Rate for Payer: First Health Commercial |
$118.80
|
| Rate for Payer: First Health Workers Compensation |
$50.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$118.80
|
| Rate for Payer: GEHA Commercial |
$92.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$118.80
|
| Rate for Payer: Multiplan All |
$120.12
|
| Rate for Payer: OMNI Networks Commercial |
$92.40
|
| Rate for Payer: One Health Plan PPO/POS |
$118.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$125.40
|
| Rate for Payer: Three Rivers Provider Network All |
$99.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$122.76
|
| Rate for Payer: Zelis Auto |
$52.80
|
| Rate for Payer: Zelis Worker's Compensation |
$36.04
|
|
|
96118 NEUROPSYCH TST BY PSYCH/PHYS
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
CPT 96118
|
| Hospital Charge Code |
21700029
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$80.26 |
| Max. Negotiated Rate |
$279.30 |
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna Commercial |
$249.90
|
| Rate for Payer: First Health Commercial |
$264.60
|
| Rate for Payer: First Health Workers Compensation |
$113.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$264.60
|
| Rate for Payer: GEHA Commercial |
$205.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$264.60
|
| Rate for Payer: Multiplan All |
$267.54
|
| Rate for Payer: OMNI Networks Commercial |
$205.80
|
| Rate for Payer: One Health Plan PPO/POS |
$264.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$279.30
|
| Rate for Payer: Three Rivers Provider Network All |
$220.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$273.42
|
| Rate for Payer: Zelis Auto |
$117.60
|
| Rate for Payer: Zelis Worker's Compensation |
$80.26
|
|
|
96118 NEUROPSYCH TST BY PSYCH/PHYS
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
CPT 96118
|
| Hospital Charge Code |
21700029
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$279.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$176.40
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna Commercial |
$249.90
|
| Rate for Payer: First Health Commercial |
$264.60
|
| Rate for Payer: First Health Workers Compensation |
$113.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$264.60
|
| Rate for Payer: GEHA Commercial |
$235.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$264.60
|
| Rate for Payer: Humana ChoiceCare |
$76.44
|
| Rate for Payer: Multiplan All |
$267.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$176.40
|
| Rate for Payer: OMNI Networks Commercial |
$205.80
|
| Rate for Payer: One Health Plan PPO/POS |
$264.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$279.30
|
| Rate for Payer: Three Rivers Provider Network All |
$220.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$258.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$73.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$273.42
|
| Rate for Payer: Zelis Auto |
$117.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$147.00
|
| Rate for Payer: Zelis Worker's Compensation |
$80.26
|
|
