|
92585 AUDITORY EVOKED POTENTIALS COMP
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
CPT 92585
|
| Hospital Charge Code |
21700003
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$106.74 |
| Max. Negotiated Rate |
$371.45 |
| Rate for Payer: Cash Price |
$234.60
|
| Rate for Payer: Cigna Commercial |
$332.35
|
| Rate for Payer: First Health Commercial |
$351.90
|
| Rate for Payer: First Health Workers Compensation |
$150.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$351.90
|
| Rate for Payer: GEHA Commercial |
$273.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$351.90
|
| Rate for Payer: Multiplan All |
$355.81
|
| Rate for Payer: OMNI Networks Commercial |
$273.70
|
| Rate for Payer: One Health Plan PPO/POS |
$351.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$371.45
|
| Rate for Payer: Three Rivers Provider Network All |
$293.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$363.63
|
| Rate for Payer: Zelis Auto |
$156.40
|
| Rate for Payer: Zelis Worker's Compensation |
$106.74
|
|
|
92585 AUDITORY EVOKED POTENTIALS COMP
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
CPT 92585
|
| Hospital Charge Code |
21700003
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$97.75 |
| Max. Negotiated Rate |
$371.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$234.60
|
| Rate for Payer: Cash Price |
$234.60
|
| Rate for Payer: Cigna Commercial |
$332.35
|
| Rate for Payer: First Health Commercial |
$351.90
|
| Rate for Payer: First Health Workers Compensation |
$150.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$351.90
|
| Rate for Payer: GEHA Commercial |
$312.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$351.90
|
| Rate for Payer: Humana ChoiceCare |
$101.66
|
| Rate for Payer: Multiplan All |
$355.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$234.60
|
| Rate for Payer: OMNI Networks Commercial |
$273.70
|
| Rate for Payer: One Health Plan PPO/POS |
$351.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$371.45
|
| Rate for Payer: Three Rivers Provider Network All |
$293.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$344.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$97.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$363.63
|
| Rate for Payer: Zelis Auto |
$156.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$195.50
|
| Rate for Payer: Zelis Worker's Compensation |
$106.74
|
|
|
92585 AUDITORY EVOKED POTENTIALS COMP
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
CPT 92585
|
| Hospital Charge Code |
21900112
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$97.75 |
| Max. Negotiated Rate |
$371.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$234.60
|
| Rate for Payer: Cash Price |
$234.60
|
| Rate for Payer: Cigna Commercial |
$332.35
|
| Rate for Payer: First Health Commercial |
$351.90
|
| Rate for Payer: First Health Workers Compensation |
$150.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$351.90
|
| Rate for Payer: GEHA Commercial |
$312.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$351.90
|
| Rate for Payer: Humana ChoiceCare |
$101.66
|
| Rate for Payer: Multiplan All |
$355.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$234.60
|
| Rate for Payer: OMNI Networks Commercial |
$273.70
|
| Rate for Payer: One Health Plan PPO/POS |
$351.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$371.45
|
| Rate for Payer: Three Rivers Provider Network All |
$293.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$344.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$97.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$363.63
|
| Rate for Payer: Zelis Auto |
$156.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$195.50
|
| Rate for Payer: Zelis Worker's Compensation |
$106.74
|
|
|
92585 AUDITORY EVOKED POTENTIALS COMP
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
CPT 92585
|
| Hospital Charge Code |
21900112
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$106.74 |
| Max. Negotiated Rate |
$371.45 |
| Rate for Payer: Cash Price |
$234.60
|
| Rate for Payer: Cigna Commercial |
$332.35
|
| Rate for Payer: First Health Commercial |
$351.90
|
| Rate for Payer: First Health Workers Compensation |
$150.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$351.90
|
| Rate for Payer: GEHA Commercial |
$273.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$351.90
|
| Rate for Payer: Multiplan All |
$355.81
|
| Rate for Payer: OMNI Networks Commercial |
$273.70
|
| Rate for Payer: One Health Plan PPO/POS |
$351.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$371.45
|
| Rate for Payer: Three Rivers Provider Network All |
$293.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$363.63
|
| Rate for Payer: Zelis Auto |
$156.40
|
| Rate for Payer: Zelis Worker's Compensation |
$106.74
|
|
|
93016 MD SUPERV ONLY
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 93016
|
| Hospital Charge Code |
8600002
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$60.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$54.40
|
| Rate for Payer: First Health Commercial |
$57.60
|
| Rate for Payer: First Health Workers Compensation |
$24.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$57.60
|
| Rate for Payer: GEHA Commercial |
$51.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$57.60
|
| Rate for Payer: Humana ChoiceCare |
$16.64
|
| Rate for Payer: Multiplan All |
$58.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$38.40
|
| Rate for Payer: OMNI Networks Commercial |
$44.80
|
| Rate for Payer: One Health Plan PPO/POS |
$57.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$60.80
|
| Rate for Payer: Three Rivers Provider Network All |
$48.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$56.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$59.52
|
| Rate for Payer: Zelis Auto |
$25.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$32.00
|
| Rate for Payer: Zelis Worker's Compensation |
$17.47
|
|
|
93016 MD SUPERV ONLY
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 93016
|
| Hospital Charge Code |
8600002
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$60.80 |
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$54.40
|
| Rate for Payer: First Health Commercial |
$57.60
|
| Rate for Payer: First Health Workers Compensation |
$24.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$57.60
|
| Rate for Payer: GEHA Commercial |
$44.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$57.60
|
| Rate for Payer: Multiplan All |
$58.24
|
| Rate for Payer: OMNI Networks Commercial |
$44.80
|
| Rate for Payer: One Health Plan PPO/POS |
$57.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$60.80
|
| Rate for Payer: Three Rivers Provider Network All |
$48.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$59.52
|
| Rate for Payer: Zelis Auto |
$25.60
|
| Rate for Payer: Zelis Worker's Compensation |
$17.47
|
|
|
93017 TRACING ONLY (TECH)
|
Facility
|
IP
|
$608.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
8600003
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$165.98 |
| Max. Negotiated Rate |
$577.60 |
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cigna Commercial |
$516.80
|
| Rate for Payer: First Health Commercial |
$547.20
|
| Rate for Payer: First Health Workers Compensation |
$234.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$547.20
|
| Rate for Payer: GEHA Commercial |
$425.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$547.20
|
| Rate for Payer: Multiplan All |
$553.28
|
| Rate for Payer: OMNI Networks Commercial |
$425.60
|
| Rate for Payer: One Health Plan PPO/POS |
$547.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$577.60
|
| Rate for Payer: Three Rivers Provider Network All |
$456.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$565.44
|
| Rate for Payer: Zelis Auto |
$243.20
|
| Rate for Payer: Zelis Worker's Compensation |
$165.98
|
|
|
93017 TRACING ONLY (TECH)
|
Facility
|
OP
|
$608.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
8600003
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$165.98 |
| Max. Negotiated Rate |
$603.48 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$356.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$364.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$356.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$282.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$301.74
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cigna Commercial |
$516.80
|
| Rate for Payer: First Health Commercial |
$547.20
|
| Rate for Payer: First Health Workers Compensation |
$234.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$547.20
|
| Rate for Payer: GEHA Commercial |
$486.40
|
| Rate for Payer: GEHA Medicare |
$301.74
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$547.20
|
| 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 |
$288.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$301.74
|
| Rate for Payer: Multiplan All |
$553.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$512.96
|
| Rate for Payer: OMNI Networks Commercial |
$425.60
|
| Rate for Payer: One Health Plan PPO/POS |
$547.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$333.13
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$288.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$301.74
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$577.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$603.48
|
| Rate for Payer: Three Rivers Provider Network All |
$456.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$295.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$288.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$301.74
|
| Rate for Payer: United Payors & United Providers UP&UP |
$565.44
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$301.74
|
| Rate for Payer: Zelis Auto |
$243.20
|
| Rate for Payer: Zelis Medicare |
$256.48
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$362.09
|
| Rate for Payer: Zelis Worker's Compensation |
$165.98
|
|
|
93018 INTERP & RPT ONLY
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 93018
|
| Hospital Charge Code |
8600004
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$11.47 |
| Max. Negotiated Rate |
$39.90 |
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$35.70
|
| Rate for Payer: First Health Commercial |
$37.80
|
| Rate for Payer: First Health Workers Compensation |
$16.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$37.80
|
| Rate for Payer: GEHA Commercial |
$29.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$37.80
|
| Rate for Payer: Multiplan All |
$38.22
|
| Rate for Payer: OMNI Networks Commercial |
$29.40
|
| Rate for Payer: One Health Plan PPO/POS |
$37.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$39.90
|
| Rate for Payer: Three Rivers Provider Network All |
$31.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$39.06
|
| Rate for Payer: Zelis Auto |
$16.80
|
| Rate for Payer: Zelis Worker's Compensation |
$11.47
|
|
|
93018 INTERP & RPT ONLY
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 93018
|
| Hospital Charge Code |
8600004
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$39.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$35.70
|
| Rate for Payer: First Health Commercial |
$37.80
|
| Rate for Payer: First Health Workers Compensation |
$16.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$37.80
|
| Rate for Payer: GEHA Commercial |
$33.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$37.80
|
| Rate for Payer: Humana ChoiceCare |
$10.92
|
| Rate for Payer: Multiplan All |
$38.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$25.20
|
| Rate for Payer: OMNI Networks Commercial |
$29.40
|
| Rate for Payer: One Health Plan PPO/POS |
$37.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$39.90
|
| Rate for Payer: Three Rivers Provider Network All |
$31.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$36.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$10.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$39.06
|
| Rate for Payer: Zelis Auto |
$16.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$21.00
|
| Rate for Payer: Zelis Worker's Compensation |
$11.47
|
|
|
93040 EKG RHYTHM STRIP
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 93040
|
| Hospital Charge Code |
21793040
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$48.45 |
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$43.35
|
| Rate for Payer: First Health Commercial |
$45.90
|
| Rate for Payer: First Health Workers Compensation |
$19.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$45.90
|
| Rate for Payer: GEHA Commercial |
$35.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$45.90
|
| Rate for Payer: Multiplan All |
$46.41
|
| Rate for Payer: OMNI Networks Commercial |
$35.70
|
| Rate for Payer: One Health Plan PPO/POS |
$45.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$48.45
|
| Rate for Payer: Three Rivers Provider Network All |
$38.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$47.43
|
| Rate for Payer: Zelis Auto |
$20.40
|
| Rate for Payer: Zelis Worker's Compensation |
$13.92
|
|
|
93040 EKG RHYTHM STRIP
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 93040
|
| Hospital Charge Code |
21900159
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$48.45 |
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$43.35
|
| Rate for Payer: First Health Commercial |
$45.90
|
| Rate for Payer: First Health Workers Compensation |
$19.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$45.90
|
| Rate for Payer: GEHA Commercial |
$35.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$45.90
|
| Rate for Payer: Multiplan All |
$46.41
|
| Rate for Payer: OMNI Networks Commercial |
$35.70
|
| Rate for Payer: One Health Plan PPO/POS |
$45.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$48.45
|
| Rate for Payer: Three Rivers Provider Network All |
$38.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$47.43
|
| Rate for Payer: Zelis Auto |
$20.40
|
| Rate for Payer: Zelis Worker's Compensation |
$13.92
|
|
|
93040 EKG RHYTHM STRIP
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 93040
|
| Hospital Charge Code |
21900159
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$48.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$43.35
|
| Rate for Payer: First Health Commercial |
$45.90
|
| Rate for Payer: First Health Workers Compensation |
$19.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$45.90
|
| Rate for Payer: GEHA Commercial |
$40.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$45.90
|
| Rate for Payer: Humana ChoiceCare |
$13.26
|
| Rate for Payer: Multiplan All |
$46.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$30.60
|
| Rate for Payer: OMNI Networks Commercial |
$35.70
|
| Rate for Payer: One Health Plan PPO/POS |
$45.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$48.45
|
| Rate for Payer: Three Rivers Provider Network All |
$38.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$44.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$12.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$47.43
|
| Rate for Payer: Zelis Auto |
$20.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$25.50
|
| Rate for Payer: Zelis Worker's Compensation |
$13.92
|
|
|
93040 EKG RHYTHM STRIP
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 93040
|
| Hospital Charge Code |
21793040
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$48.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$43.35
|
| Rate for Payer: First Health Commercial |
$45.90
|
| Rate for Payer: First Health Workers Compensation |
$19.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$45.90
|
| Rate for Payer: GEHA Commercial |
$40.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$45.90
|
| Rate for Payer: Humana ChoiceCare |
$13.26
|
| Rate for Payer: Multiplan All |
$46.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$30.60
|
| Rate for Payer: OMNI Networks Commercial |
$35.70
|
| Rate for Payer: One Health Plan PPO/POS |
$45.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$48.45
|
| Rate for Payer: Three Rivers Provider Network All |
$38.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$44.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$12.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$47.43
|
| Rate for Payer: Zelis Auto |
$20.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$25.50
|
| Rate for Payer: Zelis Worker's Compensation |
$13.92
|
|
|
93225 RECORDING ONL
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 93225
|
| Hospital Charge Code |
8600006
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$19.93 |
| Max. Negotiated Rate |
$249.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$117.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$43.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$117.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$93.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$124.90
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$62.05
|
| Rate for Payer: First Health Commercial |
$65.70
|
| Rate for Payer: First Health Workers Compensation |
$28.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$65.70
|
| Rate for Payer: GEHA Commercial |
$58.40
|
| Rate for Payer: GEHA Medicare |
$124.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$65.70
|
| 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 |
$95.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$124.90
|
| Rate for Payer: Multiplan All |
$66.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$212.33
|
| Rate for Payer: OMNI Networks Commercial |
$51.10
|
| Rate for Payer: One Health Plan PPO/POS |
$65.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$109.82
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$95.11
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$124.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$69.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$249.80
|
| Rate for Payer: Three Rivers Provider Network All |
$54.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$122.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$95.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$124.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$67.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$124.90
|
| Rate for Payer: Zelis Auto |
$29.20
|
| Rate for Payer: Zelis Medicare |
$106.17
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$149.88
|
| Rate for Payer: Zelis Worker's Compensation |
$19.93
|
|
|
93225 RECORDING ONL
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
CPT 93225
|
| Hospital Charge Code |
8600006
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$19.93 |
| Max. Negotiated Rate |
$69.35 |
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$62.05
|
| Rate for Payer: First Health Commercial |
$65.70
|
| Rate for Payer: First Health Workers Compensation |
$28.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$65.70
|
| Rate for Payer: GEHA Commercial |
$51.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$65.70
|
| Rate for Payer: Multiplan All |
$66.43
|
| Rate for Payer: OMNI Networks Commercial |
$51.10
|
| Rate for Payer: One Health Plan PPO/POS |
$65.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$69.35
|
| Rate for Payer: Three Rivers Provider Network All |
$54.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$67.89
|
| Rate for Payer: Zelis Auto |
$29.20
|
| Rate for Payer: Zelis Worker's Compensation |
$19.93
|
|
|
93226 SCAN ALALYSIS W/RP
|
Facility
|
IP
|
$377.00
|
|
|
Service Code
|
CPT 93226
|
| Hospital Charge Code |
8600007
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$102.92 |
| Max. Negotiated Rate |
$358.15 |
| Rate for Payer: Cash Price |
$226.20
|
| Rate for Payer: Cigna Commercial |
$320.45
|
| Rate for Payer: First Health Commercial |
$339.30
|
| Rate for Payer: First Health Workers Compensation |
$145.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$339.30
|
| Rate for Payer: GEHA Commercial |
$263.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$339.30
|
| Rate for Payer: Multiplan All |
$343.07
|
| Rate for Payer: OMNI Networks Commercial |
$263.90
|
| Rate for Payer: One Health Plan PPO/POS |
$339.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$358.15
|
| Rate for Payer: Three Rivers Provider Network All |
$282.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$350.61
|
| Rate for Payer: Zelis Auto |
$150.80
|
| Rate for Payer: Zelis Worker's Compensation |
$102.92
|
|
|
93226 SCAN ALALYSIS W/RP
|
Facility
|
OP
|
$377.00
|
|
|
Service Code
|
CPT 93226
|
| Hospital Charge Code |
8600007
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$48.93 |
| Max. Negotiated Rate |
$358.15 |
| Rate for Payer: Cigna Commercial |
$320.45
|
| Rate for Payer: First Health Commercial |
$339.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$117.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$226.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$117.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$93.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$57.56
|
| Rate for Payer: Cash Price |
$226.20
|
| Rate for Payer: Cash Price |
$226.20
|
| Rate for Payer: First Health Workers Compensation |
$145.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$339.30
|
| Rate for Payer: GEHA Commercial |
$301.60
|
| Rate for Payer: GEHA Medicare |
$57.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$339.30
|
| Rate for Payer: Humana ChoiceCare |
$63.32
|
| Rate for Payer: Humana Medicare Advantage |
$57.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$96.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$95.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$57.56
|
| Rate for Payer: Multiplan All |
$343.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$97.85
|
| Rate for Payer: OMNI Networks Commercial |
$263.90
|
| Rate for Payer: One Health Plan PPO/POS |
$339.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$109.82
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$95.11
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$57.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$358.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$115.12
|
| Rate for Payer: Three Rivers Provider Network All |
$282.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$56.41
|
| Rate for Payer: United Healthcare Managed Medicaid |
$95.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$57.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$350.61
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$57.56
|
| Rate for Payer: Zelis Auto |
$150.80
|
| Rate for Payer: Zelis Medicare |
$48.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$69.07
|
| Rate for Payer: Zelis Worker's Compensation |
$102.92
|
|
|
93227 MD REVIEW & INTERP
|
Facility
|
IP
|
$940.00
|
|
|
Service Code
|
CPT 93227
|
| Hospital Charge Code |
9000004
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$256.62 |
| Max. Negotiated Rate |
$893.00 |
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cigna Commercial |
$799.00
|
| Rate for Payer: First Health Commercial |
$846.00
|
| Rate for Payer: First Health Workers Compensation |
$362.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$846.00
|
| Rate for Payer: GEHA Commercial |
$658.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$846.00
|
| Rate for Payer: Multiplan All |
$855.40
|
| Rate for Payer: OMNI Networks Commercial |
$658.00
|
| Rate for Payer: One Health Plan PPO/POS |
$846.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$893.00
|
| Rate for Payer: Three Rivers Provider Network All |
$705.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$874.20
|
| Rate for Payer: Zelis Auto |
$376.00
|
| Rate for Payer: Zelis Worker's Compensation |
$256.62
|
|
|
93227 MD REVIEW & INTERP
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
CPT 93227
|
| Hospital Charge Code |
9000004
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$235.00 |
| Max. Negotiated Rate |
$893.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$564.00
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cigna Commercial |
$799.00
|
| Rate for Payer: First Health Commercial |
$846.00
|
| Rate for Payer: First Health Workers Compensation |
$362.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$846.00
|
| Rate for Payer: GEHA Commercial |
$752.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$846.00
|
| Rate for Payer: Humana ChoiceCare |
$244.40
|
| Rate for Payer: Multiplan All |
$855.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$564.00
|
| Rate for Payer: OMNI Networks Commercial |
$658.00
|
| Rate for Payer: One Health Plan PPO/POS |
$846.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$893.00
|
| Rate for Payer: Three Rivers Provider Network All |
$705.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$827.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$235.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$874.20
|
| Rate for Payer: Zelis Auto |
$376.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$470.00
|
| Rate for Payer: Zelis Worker's Compensation |
$256.62
|
|
|
93228 XTRNL MOBI CV TELE W/I&REPORT 30
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
CPT 93228
|
| Hospital Charge Code |
8693228
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$22.66 |
| Max. Negotiated Rate |
$78.85 |
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cigna Commercial |
$70.55
|
| Rate for Payer: First Health Commercial |
$74.70
|
| Rate for Payer: First Health Workers Compensation |
$32.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$74.70
|
| Rate for Payer: GEHA Commercial |
$58.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$74.70
|
| Rate for Payer: Multiplan All |
$75.53
|
| Rate for Payer: OMNI Networks Commercial |
$58.10
|
| Rate for Payer: One Health Plan PPO/POS |
$74.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$78.85
|
| Rate for Payer: Three Rivers Provider Network All |
$62.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$77.19
|
| Rate for Payer: Zelis Auto |
$33.20
|
| Rate for Payer: Zelis Worker's Compensation |
$22.66
|
|
|
93228 XTRNL MOBI CV TELE W/I&REPORT 30
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
CPT 93228
|
| Hospital Charge Code |
8693228
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$20.75 |
| Max. Negotiated Rate |
$78.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$49.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cigna Commercial |
$70.55
|
| Rate for Payer: First Health Commercial |
$74.70
|
| Rate for Payer: First Health Workers Compensation |
$32.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$74.70
|
| Rate for Payer: GEHA Commercial |
$66.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$74.70
|
| Rate for Payer: Humana ChoiceCare |
$21.58
|
| Rate for Payer: Multiplan All |
$75.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$49.80
|
| Rate for Payer: OMNI Networks Commercial |
$58.10
|
| Rate for Payer: One Health Plan PPO/POS |
$74.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$78.85
|
| Rate for Payer: Three Rivers Provider Network All |
$62.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$73.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$20.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$77.19
|
| Rate for Payer: Zelis Auto |
$33.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$41.50
|
| Rate for Payer: Zelis Worker's Compensation |
$22.66
|
|
|
93279 PM DEVICE PROGR EVAL SN
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 93279
|
| Hospital Charge Code |
9000006
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$37.95 |
| Max. Negotiated Rate |
$132.05 |
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cigna Commercial |
$118.15
|
| Rate for Payer: First Health Commercial |
$125.10
|
| Rate for Payer: First Health Workers Compensation |
$53.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$125.10
|
| Rate for Payer: GEHA Commercial |
$97.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$125.10
|
| Rate for Payer: Multiplan All |
$126.49
|
| Rate for Payer: OMNI Networks Commercial |
$97.30
|
| Rate for Payer: One Health Plan PPO/POS |
$125.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$132.05
|
| Rate for Payer: Three Rivers Provider Network All |
$104.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$129.27
|
| Rate for Payer: Zelis Auto |
$55.60
|
| Rate for Payer: Zelis Worker's Compensation |
$37.95
|
|
|
93279 PM DEVICE PROGR EVAL SN
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 93279
|
| Hospital Charge Code |
9000006
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$30.71 |
| Max. Negotiated Rate |
$132.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$52.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$83.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$52.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$41.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$36.13
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cigna Commercial |
$118.15
|
| Rate for Payer: First Health Commercial |
$125.10
|
| Rate for Payer: First Health Workers Compensation |
$53.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$125.10
|
| Rate for Payer: GEHA Commercial |
$111.20
|
| Rate for Payer: GEHA Medicare |
$36.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$125.10
|
| Rate for Payer: Humana ChoiceCare |
$39.74
|
| Rate for Payer: Humana Medicare Advantage |
$36.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$60.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$42.61
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$36.13
|
| Rate for Payer: Multiplan All |
$126.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$61.42
|
| Rate for Payer: OMNI Networks Commercial |
$97.30
|
| Rate for Payer: One Health Plan PPO/POS |
$125.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$49.20
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$42.61
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$36.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$132.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$72.26
|
| Rate for Payer: Three Rivers Provider Network All |
$104.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$35.41
|
| Rate for Payer: United Healthcare Managed Medicaid |
$42.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$129.27
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$36.13
|
| Rate for Payer: Zelis Auto |
$55.60
|
| Rate for Payer: Zelis Medicare |
$30.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$43.36
|
| Rate for Payer: Zelis Worker's Compensation |
$37.95
|
|
|
93280 PM DEVICE PROGR EVAL, DU
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 93280
|
| Hospital Charge Code |
9000007
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$30.71 |
| Max. Negotiated Rate |
$155.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$52.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$98.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$52.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$41.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$36.13
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$139.40
|
| Rate for Payer: First Health Commercial |
$147.60
|
| Rate for Payer: First Health Workers Compensation |
$63.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$131.20
|
| Rate for Payer: GEHA Medicare |
$36.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| Rate for Payer: Humana ChoiceCare |
$39.74
|
| Rate for Payer: Humana Medicare Advantage |
$36.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$60.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$42.61
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$36.13
|
| Rate for Payer: Multiplan All |
$149.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$61.42
|
| Rate for Payer: OMNI Networks Commercial |
$114.80
|
| Rate for Payer: One Health Plan PPO/POS |
$147.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$49.20
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$42.61
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$36.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$155.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$72.26
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$35.41
|
| Rate for Payer: United Healthcare Managed Medicaid |
$42.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$152.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$36.13
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Medicare |
$30.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$43.36
|
| Rate for Payer: Zelis Worker's Compensation |
$44.77
|
|
