|
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 PREVENTIVE MED NEW PT 12-17YRS
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 99384
|
| Hospital Charge Code |
21600068
|
|
Hospital Revenue Code
|
517
|
| 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 PREVENTIVE MED NEW PT 12-17YRS
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 99384
|
| Hospital Charge Code |
25500068
|
|
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 PREVENTIVE MED NEW PT 12-17YRS
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 99384
|
| Hospital Charge Code |
21600068
|
|
Hospital Revenue Code
|
517
|
| 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 PREVENTIVE MED NEW PT 12-17YRS
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 99384
|
| Hospital Charge Code |
21599384
|
|
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 PREVENTIVE MED NEW PT 12-17YRS
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 99384
|
| Hospital Charge Code |
25500068
|
|
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 PREVENTIVE MED NEW PT 12-17YRS
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 99384
|
| Hospital Charge Code |
21599384
|
|
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
|
|
|
99385 INITIAL PREVENT MED NEW PT 18-39YR
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 99385
|
| Hospital Charge Code |
21799459
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$90.64 |
| Max. Negotiated Rate |
$315.40 |
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cigna Commercial |
$282.20
|
| Rate for Payer: First Health Commercial |
$298.80
|
| Rate for Payer: First Health Workers Compensation |
$128.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$298.80
|
| Rate for Payer: GEHA Commercial |
$232.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$298.80
|
| Rate for Payer: Multiplan All |
$302.12
|
| Rate for Payer: OMNI Networks Commercial |
$232.40
|
| Rate for Payer: One Health Plan PPO/POS |
$298.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$315.40
|
| Rate for Payer: Three Rivers Provider Network All |
$249.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$308.76
|
| Rate for Payer: Zelis Auto |
$132.80
|
| Rate for Payer: Zelis Worker's Compensation |
$90.64
|
|
|
99385 INITIAL PREVENT MED NEW PT 18-39YR
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
CPT 99385
|
| Hospital Charge Code |
23500031
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$86.32 |
| Max. Negotiated Rate |
$315.40 |
| 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 |
$199.20
|
| 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 |
$199.20
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cigna Commercial |
$282.20
|
| Rate for Payer: First Health Commercial |
$298.80
|
| Rate for Payer: First Health Workers Compensation |
$128.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$298.80
|
| Rate for Payer: GEHA Commercial |
$265.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$298.80
|
| Rate for Payer: Humana ChoiceCare |
$86.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$137.55
|
| Rate for Payer: Multiplan All |
$302.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$199.20
|
| Rate for Payer: OMNI Networks Commercial |
$232.40
|
| Rate for Payer: One Health Plan PPO/POS |
$298.80
|
| 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 |
$315.40
|
| Rate for Payer: Three Rivers Provider Network All |
$249.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$292.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$137.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$308.76
|
| Rate for Payer: Zelis Auto |
$132.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$166.00
|
| Rate for Payer: Zelis Worker's Compensation |
$90.64
|
|
|
99385 INITIAL PREVENT MED NEW PT 18-39YR
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
CPT 99385
|
| Hospital Charge Code |
21799459
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$86.32 |
| Max. Negotiated Rate |
$315.40 |
| 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 |
$199.20
|
| 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 |
$199.20
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cigna Commercial |
$282.20
|
| Rate for Payer: First Health Commercial |
$298.80
|
| Rate for Payer: First Health Workers Compensation |
$128.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$298.80
|
| Rate for Payer: GEHA Commercial |
$265.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$298.80
|
| Rate for Payer: Humana ChoiceCare |
$86.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$137.55
|
| Rate for Payer: Multiplan All |
$302.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$199.20
|
| Rate for Payer: OMNI Networks Commercial |
$232.40
|
| Rate for Payer: One Health Plan PPO/POS |
$298.80
|
| 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 |
$315.40
|
| Rate for Payer: Three Rivers Provider Network All |
$249.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$292.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$137.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$308.76
|
| Rate for Payer: Zelis Auto |
$132.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$166.00
|
| Rate for Payer: Zelis Worker's Compensation |
$90.64
|
|
|
99385 INITIAL PREVENT MED NEW PT 18-39YR
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
CPT 99385
|
| Hospital Charge Code |
21999385
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$86.32 |
| Max. Negotiated Rate |
$315.40 |
| 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 |
$199.20
|
| 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 |
$199.20
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cigna Commercial |
$282.20
|
| Rate for Payer: First Health Commercial |
$298.80
|
| Rate for Payer: First Health Workers Compensation |
$128.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$298.80
|
| Rate for Payer: GEHA Commercial |
$265.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$298.80
|
| Rate for Payer: Humana ChoiceCare |
$86.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$137.55
|
| Rate for Payer: Multiplan All |
$302.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$199.20
|
| Rate for Payer: OMNI Networks Commercial |
$232.40
|
| Rate for Payer: One Health Plan PPO/POS |
$298.80
|
| 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 |
$315.40
|
| Rate for Payer: Three Rivers Provider Network All |
$249.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$292.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$137.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$308.76
|
| Rate for Payer: Zelis Auto |
$132.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$166.00
|
| Rate for Payer: Zelis Worker's Compensation |
$90.64
|
|
|
99385 INITIAL PREVENT MED NEW PT 18-39YR
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 99385
|
| Hospital Charge Code |
23500031
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$90.64 |
| Max. Negotiated Rate |
$315.40 |
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cigna Commercial |
$282.20
|
| Rate for Payer: First Health Commercial |
$298.80
|
| Rate for Payer: First Health Workers Compensation |
$128.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$298.80
|
| Rate for Payer: GEHA Commercial |
$232.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$298.80
|
| Rate for Payer: Multiplan All |
$302.12
|
| Rate for Payer: OMNI Networks Commercial |
$232.40
|
| Rate for Payer: One Health Plan PPO/POS |
$298.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$315.40
|
| Rate for Payer: Three Rivers Provider Network All |
$249.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$308.76
|
| Rate for Payer: Zelis Auto |
$132.80
|
| Rate for Payer: Zelis Worker's Compensation |
$90.64
|
|
|
99385 INITIAL PREVENT MED NEW PT 18-39YR
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 99385
|
| Hospital Charge Code |
21999385
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$90.64 |
| Max. Negotiated Rate |
$315.40 |
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cigna Commercial |
$282.20
|
| Rate for Payer: First Health Commercial |
$298.80
|
| Rate for Payer: First Health Workers Compensation |
$128.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$298.80
|
| Rate for Payer: GEHA Commercial |
$232.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$298.80
|
| Rate for Payer: Multiplan All |
$302.12
|
| Rate for Payer: OMNI Networks Commercial |
$232.40
|
| Rate for Payer: One Health Plan PPO/POS |
$298.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$315.40
|
| Rate for Payer: Three Rivers Provider Network All |
$249.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$308.76
|
| Rate for Payer: Zelis Auto |
$132.80
|
| Rate for Payer: Zelis Worker's Compensation |
$90.64
|
|
|
99385 PREVENTIVE MED NEW PT 18-39YRS
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
CPT 99385
|
| Hospital Charge Code |
21600069
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$86.32 |
| Max. Negotiated Rate |
$315.40 |
| 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 |
$199.20
|
| 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 |
$199.20
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cigna Commercial |
$282.20
|
| Rate for Payer: First Health Commercial |
$298.80
|
| Rate for Payer: First Health Workers Compensation |
$128.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$298.80
|
| Rate for Payer: GEHA Commercial |
$265.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$298.80
|
| Rate for Payer: Humana ChoiceCare |
$86.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$137.55
|
| Rate for Payer: Multiplan All |
$302.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$199.20
|
| Rate for Payer: OMNI Networks Commercial |
$232.40
|
| Rate for Payer: One Health Plan PPO/POS |
$298.80
|
| 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 |
$315.40
|
| Rate for Payer: Three Rivers Provider Network All |
$249.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$292.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$137.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$308.76
|
| Rate for Payer: Zelis Auto |
$132.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$166.00
|
| Rate for Payer: Zelis Worker's Compensation |
$90.64
|
|
|
99385 PREVENTIVE MED NEW PT 18-39YRS
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
CPT 99385
|
| Hospital Charge Code |
9399385
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$86.32 |
| Max. Negotiated Rate |
$315.40 |
| Rate for Payer: Humana ChoiceCare |
$86.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$137.55
|
| Rate for Payer: Multiplan All |
$302.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$199.20
|
| Rate for Payer: OMNI Networks Commercial |
$232.40
|
| Rate for Payer: One Health Plan PPO/POS |
$298.80
|
| 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 |
$315.40
|
| Rate for Payer: Three Rivers Provider Network All |
$249.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$292.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$137.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$308.76
|
| Rate for Payer: Zelis Auto |
$132.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$166.00
|
| Rate for Payer: Zelis Worker's Compensation |
$90.64
|
| 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 |
$199.20
|
| 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 |
$199.20
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cigna Commercial |
$282.20
|
| Rate for Payer: First Health Commercial |
$298.80
|
| Rate for Payer: First Health Workers Compensation |
$128.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$298.80
|
| Rate for Payer: GEHA Commercial |
$265.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$298.80
|
|
|
99385 PREVENTIVE MED NEW PT 18-39YRS
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 99385
|
| Hospital Charge Code |
21600069
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$90.64 |
| Max. Negotiated Rate |
$315.40 |
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cigna Commercial |
$282.20
|
| Rate for Payer: First Health Commercial |
$298.80
|
| Rate for Payer: First Health Workers Compensation |
$128.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$298.80
|
| Rate for Payer: GEHA Commercial |
$232.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$298.80
|
| Rate for Payer: Multiplan All |
$302.12
|
| Rate for Payer: OMNI Networks Commercial |
$232.40
|
| Rate for Payer: One Health Plan PPO/POS |
$298.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$315.40
|
| Rate for Payer: Three Rivers Provider Network All |
$249.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$308.76
|
| Rate for Payer: Zelis Auto |
$132.80
|
| Rate for Payer: Zelis Worker's Compensation |
$90.64
|
|
|
99385 PREVENTIVE MED NEW PT 18-39YRS
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 99385
|
| Hospital Charge Code |
21599385
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$90.64 |
| Max. Negotiated Rate |
$315.40 |
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cigna Commercial |
$282.20
|
| Rate for Payer: First Health Commercial |
$298.80
|
| Rate for Payer: First Health Workers Compensation |
$128.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$298.80
|
| Rate for Payer: GEHA Commercial |
$232.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$298.80
|
| Rate for Payer: Multiplan All |
$302.12
|
| Rate for Payer: OMNI Networks Commercial |
$232.40
|
| Rate for Payer: One Health Plan PPO/POS |
$298.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$315.40
|
| Rate for Payer: Three Rivers Provider Network All |
$249.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$308.76
|
| Rate for Payer: Zelis Auto |
$132.80
|
| Rate for Payer: Zelis Worker's Compensation |
$90.64
|
|
|
99385 PREVENTIVE MED NEW PT 18-39YRS
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
CPT 99385
|
| Hospital Charge Code |
21599385
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$86.32 |
| Max. Negotiated Rate |
$315.40 |
| 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 |
$199.20
|
| 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 |
$199.20
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cigna Commercial |
$282.20
|
| Rate for Payer: First Health Commercial |
$298.80
|
| Rate for Payer: First Health Workers Compensation |
$128.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$298.80
|
| Rate for Payer: GEHA Commercial |
$265.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$298.80
|
| Rate for Payer: Humana ChoiceCare |
$86.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$137.55
|
| Rate for Payer: Multiplan All |
$302.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$199.20
|
| Rate for Payer: OMNI Networks Commercial |
$232.40
|
| Rate for Payer: One Health Plan PPO/POS |
$298.80
|
| 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 |
$315.40
|
| Rate for Payer: Three Rivers Provider Network All |
$249.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$292.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$137.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$308.76
|
| Rate for Payer: Zelis Auto |
$132.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$166.00
|
| Rate for Payer: Zelis Worker's Compensation |
$90.64
|
|
|
99385 PREVENTIVE MED NEW PT 18-39YRS
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 99385
|
| Hospital Charge Code |
25500069
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$90.64 |
| Max. Negotiated Rate |
$315.40 |
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cigna Commercial |
$282.20
|
| Rate for Payer: First Health Commercial |
$298.80
|
| Rate for Payer: First Health Workers Compensation |
$128.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$298.80
|
| Rate for Payer: GEHA Commercial |
$232.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$298.80
|
| Rate for Payer: Multiplan All |
$302.12
|
| Rate for Payer: OMNI Networks Commercial |
$232.40
|
| Rate for Payer: One Health Plan PPO/POS |
$298.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$315.40
|
| Rate for Payer: Three Rivers Provider Network All |
$249.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$308.76
|
| Rate for Payer: Zelis Auto |
$132.80
|
| Rate for Payer: Zelis Worker's Compensation |
$90.64
|
|
|
99385 PREVENTIVE MED NEW PT 18-39YRS
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
CPT 99385
|
| Hospital Charge Code |
25500069
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$86.32 |
| Max. Negotiated Rate |
$315.40 |
| 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 |
$199.20
|
| 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 |
$199.20
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cigna Commercial |
$282.20
|
| Rate for Payer: First Health Commercial |
$298.80
|
| Rate for Payer: First Health Workers Compensation |
$128.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$298.80
|
| Rate for Payer: GEHA Commercial |
$265.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$298.80
|
| Rate for Payer: Humana ChoiceCare |
$86.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$137.55
|
| Rate for Payer: Multiplan All |
$302.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$199.20
|
| Rate for Payer: OMNI Networks Commercial |
$232.40
|
| Rate for Payer: One Health Plan PPO/POS |
$298.80
|
| 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 |
$315.40
|
| Rate for Payer: Three Rivers Provider Network All |
$249.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$292.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$137.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$308.76
|
| Rate for Payer: Zelis Auto |
$132.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$166.00
|
| Rate for Payer: Zelis Worker's Compensation |
$90.64
|
|
|
99385 PREVENTIVE MED NEW PT 18-39YRS
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 99385
|
| Hospital Charge Code |
9399385
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$90.64 |
| Max. Negotiated Rate |
$315.40 |
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cigna Commercial |
$282.20
|
| Rate for Payer: First Health Commercial |
$298.80
|
| Rate for Payer: First Health Workers Compensation |
$128.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$298.80
|
| Rate for Payer: GEHA Commercial |
$232.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$298.80
|
| Rate for Payer: Multiplan All |
$302.12
|
| Rate for Payer: OMNI Networks Commercial |
$232.40
|
| Rate for Payer: One Health Plan PPO/POS |
$298.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$315.40
|
| Rate for Payer: Three Rivers Provider Network All |
$249.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$308.76
|
| Rate for Payer: Zelis Auto |
$132.80
|
| Rate for Payer: Zelis Worker's Compensation |
$90.64
|
|
|
99386 INITIAL PREVENT MED NEW PT 40-64YR
|
Facility
|
IP
|
$362.00
|
|
|
Service Code
|
CPT 99386
|
| Hospital Charge Code |
23500032
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$98.83 |
| Max. Negotiated Rate |
$343.90 |
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$307.70
|
| Rate for Payer: First Health Commercial |
$325.80
|
| Rate for Payer: First Health Workers Compensation |
$139.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$325.80
|
| Rate for Payer: GEHA Commercial |
$253.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$325.80
|
| Rate for Payer: Multiplan All |
$329.42
|
| Rate for Payer: OMNI Networks Commercial |
$253.40
|
| Rate for Payer: One Health Plan PPO/POS |
$325.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$343.90
|
| Rate for Payer: Three Rivers Provider Network All |
$271.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$336.66
|
| Rate for Payer: Zelis Auto |
$144.80
|
| Rate for Payer: Zelis Worker's Compensation |
$98.83
|
|
|
99386 INITIAL PREVENT MED NEW PT 40-64YR
|
Facility
|
OP
|
$362.00
|
|
|
Service Code
|
CPT 99386
|
| Hospital Charge Code |
21999386
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$90.50 |
| Max. Negotiated Rate |
$343.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$217.20
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$307.70
|
| Rate for Payer: First Health Commercial |
$325.80
|
| Rate for Payer: First Health Workers Compensation |
$139.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$325.80
|
| Rate for Payer: GEHA Commercial |
$289.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$325.80
|
| Rate for Payer: Humana ChoiceCare |
$94.12
|
| Rate for Payer: Multiplan All |
$329.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$217.20
|
| Rate for Payer: OMNI Networks Commercial |
$253.40
|
| Rate for Payer: One Health Plan PPO/POS |
$325.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$343.90
|
| Rate for Payer: Three Rivers Provider Network All |
$271.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$318.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$90.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$336.66
|
| Rate for Payer: Zelis Auto |
$144.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$181.00
|
| Rate for Payer: Zelis Worker's Compensation |
$98.83
|
|
|
99386 INITIAL PREVENT MED NEW PT 40-64YR
|
Facility
|
OP
|
$362.00
|
|
|
Service Code
|
CPT 99386
|
| Hospital Charge Code |
23500032
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$90.50 |
| Max. Negotiated Rate |
$343.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$217.20
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$307.70
|
| Rate for Payer: First Health Commercial |
$325.80
|
| Rate for Payer: First Health Workers Compensation |
$139.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$325.80
|
| Rate for Payer: GEHA Commercial |
$289.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$325.80
|
| Rate for Payer: Humana ChoiceCare |
$94.12
|
| Rate for Payer: Multiplan All |
$329.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$217.20
|
| Rate for Payer: OMNI Networks Commercial |
$253.40
|
| Rate for Payer: One Health Plan PPO/POS |
$325.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$343.90
|
| Rate for Payer: Three Rivers Provider Network All |
$271.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$318.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$90.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$336.66
|
| Rate for Payer: Zelis Auto |
$144.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$181.00
|
| Rate for Payer: Zelis Worker's Compensation |
$98.83
|
|
|
99386 INITIAL PREVENT MED NEW PT 40-64YR
|
Facility
|
IP
|
$362.00
|
|
|
Service Code
|
CPT 99386
|
| Hospital Charge Code |
21799460
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$98.83 |
| Max. Negotiated Rate |
$343.90 |
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$307.70
|
| Rate for Payer: First Health Commercial |
$325.80
|
| Rate for Payer: First Health Workers Compensation |
$139.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$325.80
|
| Rate for Payer: GEHA Commercial |
$253.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$325.80
|
| Rate for Payer: Multiplan All |
$329.42
|
| Rate for Payer: OMNI Networks Commercial |
$253.40
|
| Rate for Payer: One Health Plan PPO/POS |
$325.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$343.90
|
| Rate for Payer: Three Rivers Provider Network All |
$271.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$336.66
|
| Rate for Payer: Zelis Auto |
$144.80
|
| Rate for Payer: Zelis Worker's Compensation |
$98.83
|
|
