|
99381 PREVENTIVE MED NEW PATIENT 0-1YR
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
CPT 99381
|
| Hospital Charge Code |
21600065
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$51.74 |
| Max. Negotiated Rate |
$189.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$119.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$134.80
|
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cigna Commercial |
$169.15
|
| Rate for Payer: First Health Commercial |
$179.10
|
| Rate for Payer: First Health Workers Compensation |
$76.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$179.10
|
| Rate for Payer: GEHA Commercial |
$159.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$179.10
|
| Rate for Payer: Humana ChoiceCare |
$51.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$137.55
|
| Rate for Payer: Multiplan All |
$181.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$119.40
|
| Rate for Payer: OMNI Networks Commercial |
$139.30
|
| Rate for Payer: One Health Plan PPO/POS |
$179.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$158.82
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$137.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$189.05
|
| Rate for Payer: Three Rivers Provider Network All |
$149.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$175.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$137.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$185.07
|
| Rate for Payer: Zelis Auto |
$79.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$99.50
|
| Rate for Payer: Zelis Worker's Compensation |
$54.33
|
|
|
99381 PREVENTIVE MED NEW PATIENT 0-1YR
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
CPT 99381
|
| Hospital Charge Code |
21599381
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$51.74 |
| Max. Negotiated Rate |
$189.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$119.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$134.80
|
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cigna Commercial |
$169.15
|
| Rate for Payer: First Health Commercial |
$179.10
|
| Rate for Payer: First Health Workers Compensation |
$76.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$179.10
|
| Rate for Payer: GEHA Commercial |
$159.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$179.10
|
| Rate for Payer: Humana ChoiceCare |
$51.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$137.55
|
| Rate for Payer: Multiplan All |
$181.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$119.40
|
| Rate for Payer: OMNI Networks Commercial |
$139.30
|
| Rate for Payer: One Health Plan PPO/POS |
$179.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$158.82
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$137.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$189.05
|
| Rate for Payer: Three Rivers Provider Network All |
$149.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$175.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$137.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$185.07
|
| Rate for Payer: Zelis Auto |
$79.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$99.50
|
| Rate for Payer: Zelis Worker's Compensation |
$54.33
|
|
|
99382 INITIAL PREVENT MED NEW PT 1-4YR
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
CPT 99382
|
| Hospital Charge Code |
21799456
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$55.64 |
| Max. Negotiated Rate |
$203.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$128.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$134.80
|
| Rate for Payer: Cash Price |
$128.40
|
| Rate for Payer: Cash Price |
$128.40
|
| Rate for Payer: Cigna Commercial |
$181.90
|
| Rate for Payer: First Health Commercial |
$192.60
|
| Rate for Payer: First Health Workers Compensation |
$82.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$192.60
|
| Rate for Payer: GEHA Commercial |
$171.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$192.60
|
| Rate for Payer: Humana ChoiceCare |
$55.64
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$137.55
|
| Rate for Payer: Multiplan All |
$194.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$128.40
|
| Rate for Payer: OMNI Networks Commercial |
$149.80
|
| Rate for Payer: One Health Plan PPO/POS |
$192.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$158.82
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$137.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$203.30
|
| Rate for Payer: Three Rivers Provider Network All |
$160.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$188.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$137.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$199.02
|
| Rate for Payer: Zelis Auto |
$85.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$107.00
|
| Rate for Payer: Zelis Worker's Compensation |
$58.42
|
|
|
99382 INITIAL PREVENT MED NEW PT 1-4YR
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
CPT 99382
|
| Hospital Charge Code |
21799456
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$58.42 |
| Max. Negotiated Rate |
$203.30 |
| Rate for Payer: Cash Price |
$128.40
|
| Rate for Payer: Cigna Commercial |
$181.90
|
| Rate for Payer: First Health Commercial |
$192.60
|
| Rate for Payer: First Health Workers Compensation |
$82.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$192.60
|
| Rate for Payer: GEHA Commercial |
$149.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$192.60
|
| Rate for Payer: Multiplan All |
$194.74
|
| Rate for Payer: OMNI Networks Commercial |
$149.80
|
| Rate for Payer: One Health Plan PPO/POS |
$192.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$203.30
|
| Rate for Payer: Three Rivers Provider Network All |
$160.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$199.02
|
| Rate for Payer: Zelis Auto |
$85.60
|
| Rate for Payer: Zelis Worker's Compensation |
$58.42
|
|
|
99382 INITIAL PREVENT MED NEW PT 1-4YR
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
CPT 99382
|
| Hospital Charge Code |
21999382
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$58.42 |
| Max. Negotiated Rate |
$203.30 |
| Rate for Payer: Cash Price |
$128.40
|
| Rate for Payer: Cigna Commercial |
$181.90
|
| Rate for Payer: First Health Commercial |
$192.60
|
| Rate for Payer: First Health Workers Compensation |
$82.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$192.60
|
| Rate for Payer: GEHA Commercial |
$149.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$192.60
|
| Rate for Payer: Multiplan All |
$194.74
|
| Rate for Payer: OMNI Networks Commercial |
$149.80
|
| Rate for Payer: One Health Plan PPO/POS |
$192.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$203.30
|
| Rate for Payer: Three Rivers Provider Network All |
$160.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$199.02
|
| Rate for Payer: Zelis Auto |
$85.60
|
| Rate for Payer: Zelis Worker's Compensation |
$58.42
|
|
|
99382 INITIAL PREVENT MED NEW PT 1-4YR
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
CPT 99382
|
| Hospital Charge Code |
21999382
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$55.64 |
| Max. Negotiated Rate |
$203.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$128.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$134.80
|
| Rate for Payer: Cash Price |
$128.40
|
| Rate for Payer: Cash Price |
$128.40
|
| Rate for Payer: Cigna Commercial |
$181.90
|
| Rate for Payer: First Health Commercial |
$192.60
|
| Rate for Payer: First Health Workers Compensation |
$82.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$192.60
|
| Rate for Payer: GEHA Commercial |
$171.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$192.60
|
| Rate for Payer: Humana ChoiceCare |
$55.64
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$137.55
|
| Rate for Payer: Multiplan All |
$194.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$128.40
|
| Rate for Payer: OMNI Networks Commercial |
$149.80
|
| Rate for Payer: One Health Plan PPO/POS |
$192.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$158.82
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$137.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$203.30
|
| Rate for Payer: Three Rivers Provider Network All |
$160.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$188.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$137.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$199.02
|
| Rate for Payer: Zelis Auto |
$85.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$107.00
|
| Rate for Payer: Zelis Worker's Compensation |
$58.42
|
|
|
99382 PREVENTIVE MED NEW PATIENT 1-4 YRS
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
CPT 99382
|
| Hospital Charge Code |
21599382
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$55.64 |
| Max. Negotiated Rate |
$203.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$128.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$134.80
|
| Rate for Payer: Cash Price |
$128.40
|
| Rate for Payer: Cash Price |
$128.40
|
| Rate for Payer: Cigna Commercial |
$181.90
|
| Rate for Payer: First Health Commercial |
$192.60
|
| Rate for Payer: First Health Workers Compensation |
$82.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$192.60
|
| Rate for Payer: GEHA Commercial |
$171.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$192.60
|
| Rate for Payer: Humana ChoiceCare |
$55.64
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$137.55
|
| Rate for Payer: Multiplan All |
$194.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$128.40
|
| Rate for Payer: OMNI Networks Commercial |
$149.80
|
| Rate for Payer: One Health Plan PPO/POS |
$192.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$158.82
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$137.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$203.30
|
| Rate for Payer: Three Rivers Provider Network All |
$160.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$188.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$137.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$199.02
|
| Rate for Payer: Zelis Auto |
$85.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$107.00
|
| Rate for Payer: Zelis Worker's Compensation |
$58.42
|
|
|
99382 PREVENTIVE MED NEW PATIENT 1-4 YRS
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
CPT 99382
|
| Hospital Charge Code |
21599382
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$58.42 |
| Max. Negotiated Rate |
$203.30 |
| Rate for Payer: Cash Price |
$128.40
|
| Rate for Payer: Cigna Commercial |
$181.90
|
| Rate for Payer: First Health Commercial |
$192.60
|
| Rate for Payer: First Health Workers Compensation |
$82.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$192.60
|
| Rate for Payer: GEHA Commercial |
$149.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$192.60
|
| Rate for Payer: Multiplan All |
$194.74
|
| Rate for Payer: OMNI Networks Commercial |
$149.80
|
| Rate for Payer: One Health Plan PPO/POS |
$192.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$203.30
|
| Rate for Payer: Three Rivers Provider Network All |
$160.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$199.02
|
| Rate for Payer: Zelis Auto |
$85.60
|
| Rate for Payer: Zelis Worker's Compensation |
$58.42
|
|
|
99382 PREVENTIVE MED NEW PATIENT 4-10YRS
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
CPT 99382
|
| Hospital Charge Code |
25500066
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$58.42 |
| Max. Negotiated Rate |
$203.30 |
| Rate for Payer: Cash Price |
$128.40
|
| Rate for Payer: Cigna Commercial |
$181.90
|
| Rate for Payer: First Health Commercial |
$192.60
|
| Rate for Payer: First Health Workers Compensation |
$82.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$192.60
|
| Rate for Payer: GEHA Commercial |
$149.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$192.60
|
| Rate for Payer: Multiplan All |
$194.74
|
| Rate for Payer: OMNI Networks Commercial |
$149.80
|
| Rate for Payer: One Health Plan PPO/POS |
$192.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$203.30
|
| Rate for Payer: Three Rivers Provider Network All |
$160.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$199.02
|
| Rate for Payer: Zelis Auto |
$85.60
|
| Rate for Payer: Zelis Worker's Compensation |
$58.42
|
|
|
99382 PREVENTIVE MED NEW PATIENT 4-10YRS
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
CPT 99382
|
| Hospital Charge Code |
21600066
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$55.64 |
| Max. Negotiated Rate |
$203.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$128.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$134.80
|
| Rate for Payer: Cash Price |
$128.40
|
| Rate for Payer: Cash Price |
$128.40
|
| Rate for Payer: Cigna Commercial |
$181.90
|
| Rate for Payer: First Health Commercial |
$192.60
|
| Rate for Payer: First Health Workers Compensation |
$82.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$192.60
|
| Rate for Payer: GEHA Commercial |
$171.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$192.60
|
| Rate for Payer: Humana ChoiceCare |
$55.64
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$137.55
|
| Rate for Payer: Multiplan All |
$194.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$128.40
|
| Rate for Payer: OMNI Networks Commercial |
$149.80
|
| Rate for Payer: One Health Plan PPO/POS |
$192.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$158.82
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$137.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$203.30
|
| Rate for Payer: Three Rivers Provider Network All |
$160.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$188.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$137.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$199.02
|
| Rate for Payer: Zelis Auto |
$85.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$107.00
|
| Rate for Payer: Zelis Worker's Compensation |
$58.42
|
|
|
99382 PREVENTIVE MED NEW PATIENT 4-10YRS
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
CPT 99382
|
| Hospital Charge Code |
21600066
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$58.42 |
| Max. Negotiated Rate |
$203.30 |
| Rate for Payer: Cash Price |
$128.40
|
| Rate for Payer: Cigna Commercial |
$181.90
|
| Rate for Payer: First Health Commercial |
$192.60
|
| Rate for Payer: First Health Workers Compensation |
$82.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$192.60
|
| Rate for Payer: GEHA Commercial |
$149.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$192.60
|
| Rate for Payer: Multiplan All |
$194.74
|
| Rate for Payer: OMNI Networks Commercial |
$149.80
|
| Rate for Payer: One Health Plan PPO/POS |
$192.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$203.30
|
| Rate for Payer: Three Rivers Provider Network All |
$160.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$199.02
|
| Rate for Payer: Zelis Auto |
$85.60
|
| Rate for Payer: Zelis Worker's Compensation |
$58.42
|
|
|
99382 PREVENTIVE MED NEW PATIENT 4-10YRS
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
CPT 99382
|
| Hospital Charge Code |
25500066
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$55.64 |
| Max. Negotiated Rate |
$203.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$128.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$134.80
|
| Rate for Payer: Cash Price |
$128.40
|
| Rate for Payer: Cash Price |
$128.40
|
| Rate for Payer: Cigna Commercial |
$181.90
|
| Rate for Payer: First Health Commercial |
$192.60
|
| Rate for Payer: First Health Workers Compensation |
$82.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$192.60
|
| Rate for Payer: GEHA Commercial |
$171.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$192.60
|
| Rate for Payer: Humana ChoiceCare |
$55.64
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$137.55
|
| Rate for Payer: Multiplan All |
$194.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$128.40
|
| Rate for Payer: OMNI Networks Commercial |
$149.80
|
| Rate for Payer: One Health Plan PPO/POS |
$192.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$158.82
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$137.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$203.30
|
| Rate for Payer: Three Rivers Provider Network All |
$160.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$188.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$137.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$199.02
|
| Rate for Payer: Zelis Auto |
$85.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$107.00
|
| Rate for Payer: Zelis Worker's Compensation |
$58.42
|
|
|
99383 INITIAL PREVENT MED NEW PT 5-11YR
|
Facility
|
IP
|
$229.00
|
|
|
Service Code
|
CPT 99383
|
| Hospital Charge Code |
21799457
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.52 |
| Max. Negotiated Rate |
$217.55 |
| Rate for Payer: Cash Price |
$137.40
|
| Rate for Payer: Cigna Commercial |
$194.65
|
| Rate for Payer: First Health Commercial |
$206.10
|
| Rate for Payer: First Health Workers Compensation |
$88.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$206.10
|
| Rate for Payer: GEHA Commercial |
$160.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$206.10
|
| Rate for Payer: Multiplan All |
$208.39
|
| Rate for Payer: OMNI Networks Commercial |
$160.30
|
| Rate for Payer: One Health Plan PPO/POS |
$206.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$217.55
|
| Rate for Payer: Three Rivers Provider Network All |
$171.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$212.97
|
| Rate for Payer: Zelis Auto |
$91.60
|
| Rate for Payer: Zelis Worker's Compensation |
$62.52
|
|
|
99383 INITIAL PREVENT MED NEW PT 5-11YR
|
Facility
|
OP
|
$229.00
|
|
|
Service Code
|
CPT 99383
|
| Hospital Charge Code |
21799457
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$59.54 |
| Max. Negotiated Rate |
$217.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$137.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$134.80
|
| Rate for Payer: Cash Price |
$137.40
|
| Rate for Payer: Cash Price |
$137.40
|
| Rate for Payer: Cigna Commercial |
$194.65
|
| Rate for Payer: First Health Commercial |
$206.10
|
| Rate for Payer: First Health Workers Compensation |
$88.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$206.10
|
| Rate for Payer: GEHA Commercial |
$183.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$206.10
|
| Rate for Payer: Humana ChoiceCare |
$59.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$137.55
|
| Rate for Payer: Multiplan All |
$208.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$137.40
|
| Rate for Payer: OMNI Networks Commercial |
$160.30
|
| Rate for Payer: One Health Plan PPO/POS |
$206.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$158.82
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$137.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$217.55
|
| Rate for Payer: Three Rivers Provider Network All |
$171.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$201.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$137.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$212.97
|
| Rate for Payer: Zelis Auto |
$91.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$114.50
|
| Rate for Payer: Zelis Worker's Compensation |
$62.52
|
|
|
99383 INITIAL PREVENT MED NEW PT 5-11YR
|
Facility
|
OP
|
$229.00
|
|
|
Service Code
|
CPT 99383
|
| Hospital Charge Code |
21999383
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$59.54 |
| Max. Negotiated Rate |
$217.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$137.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$134.80
|
| Rate for Payer: Cash Price |
$137.40
|
| Rate for Payer: Cash Price |
$137.40
|
| Rate for Payer: Cigna Commercial |
$194.65
|
| Rate for Payer: First Health Commercial |
$206.10
|
| Rate for Payer: First Health Workers Compensation |
$88.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$206.10
|
| Rate for Payer: GEHA Commercial |
$183.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$206.10
|
| Rate for Payer: Humana ChoiceCare |
$59.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$137.55
|
| Rate for Payer: Multiplan All |
$208.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$137.40
|
| Rate for Payer: OMNI Networks Commercial |
$160.30
|
| Rate for Payer: One Health Plan PPO/POS |
$206.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$158.82
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$137.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$217.55
|
| Rate for Payer: Three Rivers Provider Network All |
$171.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$201.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$137.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$212.97
|
| Rate for Payer: Zelis Auto |
$91.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$114.50
|
| Rate for Payer: Zelis Worker's Compensation |
$62.52
|
|
|
99383 INITIAL PREVENT MED NEW PT 5-11YR
|
Facility
|
IP
|
$229.00
|
|
|
Service Code
|
CPT 99383
|
| Hospital Charge Code |
21999383
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.52 |
| Max. Negotiated Rate |
$217.55 |
| Rate for Payer: Cash Price |
$137.40
|
| Rate for Payer: Cigna Commercial |
$194.65
|
| Rate for Payer: First Health Commercial |
$206.10
|
| Rate for Payer: First Health Workers Compensation |
$88.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$206.10
|
| Rate for Payer: GEHA Commercial |
$160.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$206.10
|
| Rate for Payer: Multiplan All |
$208.39
|
| Rate for Payer: OMNI Networks Commercial |
$160.30
|
| Rate for Payer: One Health Plan PPO/POS |
$206.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$217.55
|
| Rate for Payer: Three Rivers Provider Network All |
$171.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$212.97
|
| Rate for Payer: Zelis Auto |
$91.60
|
| Rate for Payer: Zelis Worker's Compensation |
$62.52
|
|
|
99383 PREVENTIVE MED NEW PATIENT 5-11YRS
|
Facility
|
OP
|
$229.00
|
|
|
Service Code
|
CPT 99383
|
| Hospital Charge Code |
21600067
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$59.54 |
| Max. Negotiated Rate |
$217.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$137.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$134.80
|
| Rate for Payer: Cash Price |
$137.40
|
| Rate for Payer: Cash Price |
$137.40
|
| Rate for Payer: Cigna Commercial |
$194.65
|
| Rate for Payer: First Health Commercial |
$206.10
|
| Rate for Payer: First Health Workers Compensation |
$88.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$206.10
|
| Rate for Payer: GEHA Commercial |
$183.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$206.10
|
| Rate for Payer: Humana ChoiceCare |
$59.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$137.55
|
| Rate for Payer: Multiplan All |
$208.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$137.40
|
| Rate for Payer: OMNI Networks Commercial |
$160.30
|
| Rate for Payer: One Health Plan PPO/POS |
$206.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$158.82
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$137.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$217.55
|
| Rate for Payer: Three Rivers Provider Network All |
$171.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$201.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$137.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$212.97
|
| Rate for Payer: Zelis Auto |
$91.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$114.50
|
| Rate for Payer: Zelis Worker's Compensation |
$62.52
|
|
|
99383 PREVENTIVE MED NEW PATIENT 5-11YRS
|
Facility
|
OP
|
$229.00
|
|
|
Service Code
|
CPT 99383
|
| Hospital Charge Code |
21599383
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$59.54 |
| Max. Negotiated Rate |
$217.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$137.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$134.80
|
| Rate for Payer: Cash Price |
$137.40
|
| Rate for Payer: Cash Price |
$137.40
|
| Rate for Payer: Cigna Commercial |
$194.65
|
| Rate for Payer: First Health Commercial |
$206.10
|
| Rate for Payer: First Health Workers Compensation |
$88.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$206.10
|
| Rate for Payer: GEHA Commercial |
$183.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$206.10
|
| Rate for Payer: Humana ChoiceCare |
$59.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$137.55
|
| Rate for Payer: Multiplan All |
$208.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$137.40
|
| Rate for Payer: OMNI Networks Commercial |
$160.30
|
| Rate for Payer: One Health Plan PPO/POS |
$206.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$158.82
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$137.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$217.55
|
| Rate for Payer: Three Rivers Provider Network All |
$171.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$201.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$137.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$212.97
|
| Rate for Payer: Zelis Auto |
$91.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$114.50
|
| Rate for Payer: Zelis Worker's Compensation |
$62.52
|
|
|
99383 PREVENTIVE MED NEW PATIENT 5-11YRS
|
Facility
|
IP
|
$229.00
|
|
|
Service Code
|
CPT 99383
|
| Hospital Charge Code |
21600067
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$62.52 |
| Max. Negotiated Rate |
$217.55 |
| Rate for Payer: Cash Price |
$137.40
|
| Rate for Payer: Cigna Commercial |
$194.65
|
| Rate for Payer: First Health Commercial |
$206.10
|
| Rate for Payer: First Health Workers Compensation |
$88.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$206.10
|
| Rate for Payer: GEHA Commercial |
$160.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$206.10
|
| Rate for Payer: Multiplan All |
$208.39
|
| Rate for Payer: OMNI Networks Commercial |
$160.30
|
| Rate for Payer: One Health Plan PPO/POS |
$206.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$217.55
|
| Rate for Payer: Three Rivers Provider Network All |
$171.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$212.97
|
| Rate for Payer: Zelis Auto |
$91.60
|
| Rate for Payer: Zelis Worker's Compensation |
$62.52
|
|
|
99383 PREVENTIVE MED NEW PATIENT 5-11YRS
|
Facility
|
OP
|
$229.00
|
|
|
Service Code
|
CPT 99383
|
| Hospital Charge Code |
25500067
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$59.54 |
| Max. Negotiated Rate |
$217.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$137.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$134.80
|
| Rate for Payer: Cash Price |
$137.40
|
| Rate for Payer: Cash Price |
$137.40
|
| Rate for Payer: Cigna Commercial |
$194.65
|
| Rate for Payer: First Health Commercial |
$206.10
|
| Rate for Payer: First Health Workers Compensation |
$88.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$206.10
|
| Rate for Payer: GEHA Commercial |
$183.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$206.10
|
| Rate for Payer: Humana ChoiceCare |
$59.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$137.55
|
| Rate for Payer: Multiplan All |
$208.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$137.40
|
| Rate for Payer: OMNI Networks Commercial |
$160.30
|
| Rate for Payer: One Health Plan PPO/POS |
$206.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$158.82
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$137.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$217.55
|
| Rate for Payer: Three Rivers Provider Network All |
$171.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$201.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$137.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$212.97
|
| Rate for Payer: Zelis Auto |
$91.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$114.50
|
| Rate for Payer: Zelis Worker's Compensation |
$62.52
|
|
|
99383 PREVENTIVE MED NEW PATIENT 5-11YRS
|
Facility
|
IP
|
$229.00
|
|
|
Service Code
|
CPT 99383
|
| Hospital Charge Code |
21599383
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.52 |
| Max. Negotiated Rate |
$217.55 |
| Rate for Payer: Cash Price |
$137.40
|
| Rate for Payer: Cigna Commercial |
$194.65
|
| Rate for Payer: First Health Commercial |
$206.10
|
| Rate for Payer: First Health Workers Compensation |
$88.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$206.10
|
| Rate for Payer: GEHA Commercial |
$160.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$206.10
|
| Rate for Payer: Multiplan All |
$208.39
|
| Rate for Payer: OMNI Networks Commercial |
$160.30
|
| Rate for Payer: One Health Plan PPO/POS |
$206.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$217.55
|
| Rate for Payer: Three Rivers Provider Network All |
$171.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$212.97
|
| Rate for Payer: Zelis Auto |
$91.60
|
| Rate for Payer: Zelis Worker's Compensation |
$62.52
|
|
|
99383 PREVENTIVE MED NEW PATIENT 5-11YRS
|
Facility
|
IP
|
$229.00
|
|
|
Service Code
|
CPT 99383
|
| Hospital Charge Code |
25500067
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.52 |
| Max. Negotiated Rate |
$217.55 |
| Rate for Payer: Cash Price |
$137.40
|
| Rate for Payer: Cigna Commercial |
$194.65
|
| Rate for Payer: First Health Commercial |
$206.10
|
| Rate for Payer: First Health Workers Compensation |
$88.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$206.10
|
| Rate for Payer: GEHA Commercial |
$160.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$206.10
|
| Rate for Payer: Multiplan All |
$208.39
|
| Rate for Payer: OMNI Networks Commercial |
$160.30
|
| Rate for Payer: One Health Plan PPO/POS |
$206.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$217.55
|
| Rate for Payer: Three Rivers Provider Network All |
$171.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$212.97
|
| Rate for Payer: Zelis Auto |
$91.60
|
| Rate for Payer: Zelis Worker's Compensation |
$62.52
|
|
|
99384 INITIAL PREVENT MED NEW PT 12-17YR
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 99384
|
| Hospital Charge Code |
21799458
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$63.70 |
| Max. Negotiated Rate |
$232.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$147.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$134.80
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$208.25
|
| Rate for Payer: First Health Commercial |
$220.50
|
| Rate for Payer: First Health Workers Compensation |
$94.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$220.50
|
| Rate for Payer: GEHA Commercial |
$196.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$220.50
|
| Rate for Payer: Humana ChoiceCare |
$63.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$137.55
|
| Rate for Payer: Multiplan All |
$222.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$147.00
|
| Rate for Payer: OMNI Networks Commercial |
$171.50
|
| Rate for Payer: One Health Plan PPO/POS |
$220.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$158.82
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$137.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$232.75
|
| Rate for Payer: Three Rivers Provider Network All |
$183.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$215.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$137.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$227.85
|
| Rate for Payer: Zelis Auto |
$98.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$122.50
|
| Rate for Payer: Zelis Worker's Compensation |
$66.89
|
|
|
99384 INITIAL PREVENT MED NEW PT 12-17YR
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 99384
|
| Hospital Charge Code |
21999384
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$66.89 |
| Max. Negotiated Rate |
$232.75 |
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$208.25
|
| Rate for Payer: First Health Commercial |
$220.50
|
| Rate for Payer: First Health Workers Compensation |
$94.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$220.50
|
| Rate for Payer: GEHA Commercial |
$171.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$220.50
|
| Rate for Payer: Multiplan All |
$222.95
|
| Rate for Payer: OMNI Networks Commercial |
$171.50
|
| Rate for Payer: One Health Plan PPO/POS |
$220.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$232.75
|
| Rate for Payer: Three Rivers Provider Network All |
$183.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$227.85
|
| Rate for Payer: Zelis Auto |
$98.00
|
| Rate for Payer: Zelis Worker's Compensation |
$66.89
|
|
|
99384 INITIAL PREVENT MED NEW PT 12-17YR
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 99384
|
| Hospital Charge Code |
21799458
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$66.89 |
| Max. Negotiated Rate |
$232.75 |
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$208.25
|
| Rate for Payer: First Health Commercial |
$220.50
|
| Rate for Payer: First Health Workers Compensation |
$94.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$220.50
|
| Rate for Payer: GEHA Commercial |
$171.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$220.50
|
| Rate for Payer: Multiplan All |
$222.95
|
| Rate for Payer: OMNI Networks Commercial |
$171.50
|
| Rate for Payer: One Health Plan PPO/POS |
$220.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$232.75
|
| Rate for Payer: Three Rivers Provider Network All |
$183.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$227.85
|
| Rate for Payer: Zelis Auto |
$98.00
|
| Rate for Payer: Zelis Worker's Compensation |
$66.89
|
|
